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Members should complete both the Enrollment form and Attestation form when completing a paper application.
PDF Download
Click links below to download
- 2026 Medicare Advantage Enrollment PDF Form - English
- 2026 Medicare Advantage Enrollment PDF Form - Spanish
- 2025 Medicare Advantage Enrollment PDF Form - English
- 2025 Medicare Advantage Enrollment PDF Form - Spanish
- 2026 Medicare Enrollment Eligibility Attestation PDF form - English
- 2026 Medicare Enrollment Eligibility Attestation PDF Form - Spanish
- 2025 Medicare Enrollment Eligibility Attestation PDF Form - English
- 2025 Medicare Enrollment Eligibility Attestation PDF Form - Spanish