Note: This link will take you away from the Medicare section of the Priority Health website.
We're sorry. Our online form won't be live until Wednesday, Oct. 5. We apologize for the inconvenience.
You may fill out a PDF of the application online but you will only be able to print it, not save it to your computer.
Mail it to us at the address on the form, or wait until Wednesday and use our new online tool.
Medicap Application Form (140KB PDF)
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