Step Three: Print an Enrollment Form

Go to Step 1: Choose a plan
Go to Step 2: Read the eligibility and enrollment requirements
Complete Step 3: Print an enrollment form by clicking on a link, below
Go to Step 4: Send us your completed form

Click on the statement below that applies to the plan you are interested in. An enrollment form will appear on your screen.


I certify that I have read the enrollment information for the PriorityMedicare plan. (78KB PDF)

I certify that I have read the enrollment information for the PriorityMedicarePlus plan. (78KB PDF)

I certify that I have read the enrollment information for the PriorityMedicareRx plan. (75KB PDF)



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