By completing this online form, you'll be enrolling in a Kaiser Permanente Medicare Group health plan. If you have questions about your eligibility or need help completing this form, call Member Services from 8 a.m. to 8 p.m., 7 days a week, at 1-877-221-8221 (toll free) or TTY 711.
Note: If you are in a public place or on a shared computer, do not leave the computer unattended and make sure no one else may view your information as you fill out the form. After you have completed and submitted the form, exit your Web browser.
How can we help you?
Speak with a Kaiser Permanente Medicare specialist. Call toll free 1-855-219-7320 (TTY 711) 8 a.m. to 8 p.m., 7 days a week.
You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.
In California, Hawaii, Oregon, Washington, Colorado, Georgia and the District of Columbia, Kaiser Permanente is an HMO plan with a Medicare contract. In Maryland and Virginia, Kaiser Permanente is an HMO plan and a Cost plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
For accommodations of persons with special needs at meetings, call 1-877-220-3956 (toll free) or TTY 711.