Medicare Supplement Enrollment
Aetna Medicare Supplement: Enrollment
How To Apply for Coverage
To apply for coverage after reviewing the Aetna Medicare Supplement Plan* insurance policy, underwritten by Aetna Life Insurance Company (Aetna), as well as information about rates, copayments and benefits for your state, please follow the steps below:
- Open and print the Application for your state.
- Open and print the Notice to Applicant Regarding Replacement of Medicare Supplement Insurance for your state.
- Complete both the Application and Notice to Applicant forms.
- Write a check for your first month's premium made payable to Aetna Life Insurance Company.
- Mail:
- The completed Application for your state and
- Notice to Applicant for your state, along with
- Your check to:
Aetna Life Insurance Company
PO Box 13547
Pensacola, FL 32591-3547
*The Aetna Individual Medicare Supplement PlanSM is administered by CHCS Services, Inc.
Aetna Individual Medicare Supplement Plan Application
To open and print the Application for your state, please:
- Select your state.
- Click "Go" to open the document.
The following documents are provided in Adobe PDF format. 
Notice to Applicant Regarding Replacement of Medicare Supplement Insurance
To open and print the Notice to Applicant for your state, please:
- Select your state.
- Click "Go" to open the document.
The following documents are provided in Adobe PDF format.
You will have 30 days to review the policy for the Aetna Individual Medicare Supplement Plan you select. If you change your mind, simply return the policy within 30 days of delivery for a refund of your plan premium.
Electronic Funds Transfer (EFT)
After enrolling, if you wish to have your monthly premium automatically deducted from your checking account or charged to your credit card, please print and complete our
Electronic Funds Transfer (EFT) form (1 page, 90kb) and mail it to:
Aetna Life Insurance Company
PO Box 13547
Pensacola, FL 32591-3547
You will need Adobe Acrobat Reader to view some of the materials. You can download the latest Acrobat Reader software free by clicking this link. Download Adobe Reader
This material is for information only. This is a solicitation to sell Aetna Medicare Supplement insurance underwritten by Aetna Life Insurance Company (Aetna). A sales representative may call. Benefits and costs may vary depending upon the insurance plan. Insurance plans are subject to exclusions, limitations and eligibility requirements. Neither Aetna Life Insurance Company nor any of its agents or Medicare Supplement insurance plans are connected with or endorsed by the U.S. or state government, Social Security or Federal Medicare program.
IMPORTANT NOTICE
A Consumer's Guide to Health Insurance for People Eligible for Medicare may be obtained from your local Social Security Office or from Aetna life Insurance Company (Aetna). Download here.
Policy forms issued in NY include: GR-11613-NY-A, GR-11613-NY-B, GR-11613-NY-F.
