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Get Aetna Disenrollment Form

X 963 Blue Bell, PA 19422-9921 If you have questions, call 1-800-832-2640 or TTY/TDD 1-800-628-3323, Monday-Friday 8:00 a.m. 6:00 p.m. To enroll in the Aetna Medicare Advantage Plan, provide the following information. Check the box next to the plan you want to enroll in. Please refer to plan materials for detailed benefit information. Aetna Golden Medicare Plan (HMO)* Aetna Golden ChoiceTM Plan (PPO) Basic Select Premier Standard Regional Regional Standard Standard Value Premier Regional V.

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