Enrolling in Priority Health Medigap plans

Original Medicare and Medigap plans don't cover prescription drug costs. You may want to add PriorityMedicare Rx^SM, which would give you Medicare Part D prescription drug benefits.

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Application materials

Rates starting 4/1/2012: Medigap Outline of Coverage brochure (529KB PDF)
Medicare Supplement plans made easy.

Choosing a Medigap Policy (555KB PDF)
Read the federal government's brochure about choosing a Medigap plan.

Medigap application form (140KB PDF)
You can also apply online or by phone at 888 389-6676, from 8 a.m. to 8 p.m., 7 days a week. TTY users should call 711.

Automatic Bill Payment sign-up form (72KB PDF)
Use this form to sign up to have your premiums automatically deducted from your bank account by electronic funds transfer (EFT).
Or you can sign up when you use the online plan application. (coming soon)

PriorityMedicare Rx Summary of Benefits (228KB PDF)
Form number: S5857_1001_1012_20 CMS-approved 09142011
Summary of covered services, including copays

PriorityMedicare Rx enrollment form, instructions and checklist (196KB PDF)
Form number: S5857_2000_2001_28 CMS-approved 09152011; S5857_1009_1009_64 File and Use 08072011
You can also enroll online or by phone at 888 389-6676, from 8 a.m. to 8 p.m., 7 days a week. TTY users should call 711.

Appeals and Grievances flyer (97KB PDF)
Form number: Y0056_1009_1009_52 File and Use 09272010

Notice of Privacy Practices (91KB PDF)

Centers for Medicare and Medicaid (CMS) Star Rating (45KB PDF)
Form number:S5857_9000_9004_6 File and Use 10182011

Ways to apply

• By phone - speak to one of our Medigap experts at 888 389-6676, from 8 a.m. to 8 p.m., 7 days a week.TTY users should call 711.
• Online - by going to "Compare plans" and choosing the plan you want.
• Mail - print and fill out the paper enrollment form(s) above and mail it to: Priority Health, MS 1175, 1231 E. Beltline, Grand Rapids, MI 49525.