Get Enroll Medstar Medicare Form

Completing the Enroll Medstar Medicare Form online is a straightforward process that ensures you provide all necessary information for your enrollment. This guide will walk you through each section of the form to assist you in submitting your application accurately and efficiently.

Follow the steps to fill out the Enroll Medstar Medicare Form online.

1. Press the ‘Get Form’ button to access the enrollment form and open it in your preferred document editor.
2. In Section 1, enter your full name and permanent residence address. Ensure that the physical address is correctly filled without using a P.O. Box.
3. In Section 2, provide your Medicare information, including your name, Medicare claim number, and effective dates for Parts A and B as they appear on your Medicare card.
4. Confirm your enrollment in the MedStar Medicare Choice HMO plan in Section 3 by checking the appropriate box.
5. Select a primary care physician (PCP) in Section 4. Write down the name and practice number of your selected PCP, which can be found in the provider directory.
6. In Section 5, choose a payment option for any potential late enrollment penalties, if applicable.
7. For Sections 6 and 7, provide information about any other health insurance coverage you may have and answer questions regarding end-stage renal disease or residency in a long-term care facility.
8. In Section 8, read the statements carefully and check the boxes that apply to your situation to determine your eligibility for an enrollment period.
9. If you need the form in an alternative format, complete Section 9. If not, you can skip this section.
10. Finally, sign and date the application in the designated area to confirm that all information provided is correct.
11. After completing the form, you can save changes, download, print, or share it as required.

Complete your Enroll Medstar Medicare Form online today to ensure a smooth enrollment process.