Providence Medicare Advantage Plans Enrollment Request Form

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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

Before making an enrollment decision, it is important that you fully understand our benefits and rules. If you have any questions, you can call and speak to a sales representative at 888-728-4109 (TTY: 711), 8 a.m. to 8 p.m. (Pacific time), Seven days a week (Oct. 1-Dec. 7), Monday through Friday (Dec. 8-Sept. 30).

Understanding the Benefits
Review the full list of benefits found in the Evidence of Coverage (EOC), especially for those services for which you routinely see a doctor. Visit or call 503-574-8000 or 1-800-603-2340 (TTY: 711) to view a copy of the EOC.

Review the provider directory (or ask your doctor) to make sure the doctors you see now are in the network. If they are not listed, it means you will likely have to select a new doctor. View the directory at

Review the pharmacy directory to make sure the pharmacy you use for any prescription medicines is in the network. If the pharmacy is not listed, you will likely have to select a new pharmacy for your prescriptions.

Understanding Important Rules
In addition to your monthly plan premium (including $0 premium plans), you must continue to pay your Medicare Part B premium. This premium is normally taken out of your Social Security check each month. The Part B premium is covered for full-dual enrollees who are eligible for Providence Medicare Dual Plus (HMO D-SNP).

Benefits, premiums and/or copayments/co-insurance may change on January 1, 2020.

When selecting an HMO product, remember that except in emergency or urgent situations, we do not cover services by out-of-network providers (doctors who are not listed in the provider directory).

Our HMO-POS plans allow you to see providers outside of our network (non-contracted providers). However, while we will pay for certain covered services provided by a non-contracted provider, the provider must agree to treat you. Except in an emergency or urgent situations, non-contracted providers may deny care. In addition, you will pay a higher co-pay for services received by non-contracted providers.

Providence Medicare Dual Plus (HMO D-SNP) is a dual eligible special needs plan (D-SNP). Your ability to enroll will be based on verification that you are entitled to both Medicare and medical assistance from a state plan under Medicaid.

Providence Medicare Advantage Plans is an HMO, HMO-POS, and HMO SNP plan with Medicare and Oregon Health Plan contracts. Enrollment in Providence Medicare Advantage Plans depends on contract renewal. You must continue to pay your Medicare Part B premium.

Webpage is current as of 10/15/2019