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Medicare Supplement Enrollment

Aetna Medicare Choices

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:

  1. Open and print the Application for your state.
  2. Open and print the Notice to Applicant Regarding Replacement of Medicare Supplement Insurance for your state.
  3. Complete both the Application and Notice to Applicant forms.
  4. Write a check for your first month's premium made payable to Aetna Life Insurance Company.
  5. Mail:
    • The completed Application for your state,
    • The Notice to Applicant for your state (if applicable), and
    • Your check for the first month's premium to:
      Aetna Life Insurance Company
      P.O. Box 14399
      Lexington, KY 40512-9701

*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:

  1. Select your state.
  2. Click "Go" to open the document.

The following documents are provided in Adobe PDF format. PDF Icon

  Go

Notice to Applicant Regarding Replacement of Medicare Supplement Insurance

To open and print the Notice to Applicant for your state, please:

  1. Select your state.
  2. Click "Go" to open the document.

The following documents are provided in Adobe PDF format. PDF Icon

  Go

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) and Credit Card Option Program

To have your monthly plan premiums automatically deducted from your checking account or charged to your credit card, please print and complete the PDF Icon Electronic Funds Transfer (EFT) Authorization form (1 page, 576kb) or the PDF Icon Credit Card Payment Application (1 page, 16kb), then:

Mail the Electronic Funds Transfer (EFT) Authorization form to:
Aetna Life Insurance Company
P.O. Box 1188
Brentwood, TN 37024

Mail the Credit Card Payment Application to:
Aetna Life Insurance Company
P.O. Box 14389
Lexington, KY 40512-4389

Click here for general Medicare information contacts.

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