Providence Medicare Advantage Plans Enrollment Request Form

Elderly couple using computer

Welcome! Let's start your enrollment.

Use this online form to enroll in your preferred Providence Medicare Advantage Plan.

  • Quote
  • Apply
  • Pay
  • Enroll

Please choose which plan you want to enroll in:


Click here to see Providence Medicare Advantage Plans’ service area

* Providence Medicare Dual Plus (HMO SNP) is available to you if you have Medicare Part A and B, you have full Oregon Health Plan (OHP) Medicaid benefits, and you live in Clackamas, Multnomah or Washington County.

You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual enrollees who are eligible for Providence Medicare Dual Plus (HMO SNP). Premiums, co-pays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Providence Medicare Advantage Plans is an HMO and HMO-POS, and HMO SNP plan with a Medicare and Oregon Health Plan contract. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Medicare beneficiaries may also enroll in Providence Medicare Advantage Plans through the CMS Medicare Online Enrollment Center located at

You must continue to pay your Medicare Part B premium.

Benefits, premiums, co-payments and co-insurance may change on January 1 of each year.

Webpage is current as of 10/01/2017

H9047_2018AM20 Approved