START YOUR ENROLLMENT
You will need:
- Your Medicare ID Card
- Any medical or prescription drug coverage plan information
Other ways to enroll:
Print the application / Print the Spanish application Print the application / Print the Spanish application Print the application / Print the Spanish application / Enrollment Form -Secure / Enrollment Form - Plus / Spanish Enrollment Form - Secure / Spanish Enrollment Form - Plus and mail it to us.
No Printer? Request an application and pre-enrollment kit to be mailed to you.
Call a Member Service Representative
1-866-250-2005 (TTY users call 711), 24 hours a day, 7 days a week.
By completing the online enrollment application, you will be sending an actual enrollment request to Elixir Insurance Company. Medicare beneficiaries may also enroll in Elixir Insurance through the CMS Medicare Online Enrollment Center located at Medicare.gov. View enrollment disclaimers.