Providence Medicare Advantage Plan enrollment forms & documents

Enrollment information

Please visit our how to enroll page and read the enrollment instructions before completing enrollment forms.

Once you have completed your enrollment form, fax it to 503-574-8653 or mail to:

Providence Medicare Advantage Plans

P.O. Box 5548
Portland, OR 97228-5548

You will receive a notice in the mail acknowledging receipt of your enrollment request.

Individuals must have both Part A and Part B to enroll.

Reference documents

Resources for enrollment

2024 Enrollment forms

Do you need some extra assistance?

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If you need assistance with enrollment or with finding the information you need, our Medicare experts are here to assist you any way we can.

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