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Transcript:  Medicare Enrollment Checklist



Medicare enrollment checklist

When you’re ready to sign up for Medicare, you have three options. Apply by phone, in person at a U.S. Social Security Administration office, or online. If you decide to go in person, it’s best to make an appointment first.


Here’s what you need to take with you if you sign up inperson:

-An original or certified copy of your birth certificate or other proof of birth.

-Proof of United States citizenship or legal residency if not born in the U.S.

-Your Social Security card if you are already receiving benefits.

-A copy of your W-2 form(s) and/or self-employment tax return for last year.

-U.S. military discharge papers if you served before 1968.

-Health insurance information (type and dates of coverage).

-If you are applying for a spouse or signing up for Medicare by phone (1-800-772-1213) or in person at the Social Security office, you may need to submit additional information.


Here’s what you need to know if you sign up online:

-Dates and place of birth. If born outside the U.S., you’ll need your birth country and Permanent Resident Card number.

-Health insurance information. Start and end dates for group coverage and employment.

To apply for Medicare online, go to

(Select “Apply for Medicare Only”)





${company} Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.