Providence Medicare Advantage Plan enrollment forms & documents
Once you have completed your enrollment form, fax it to 503-574-8653 or mail to:
Providence Medicare Advantage Plans
P.O. Box 5548
Portland, OR 97228-5548
You will receive a notice in the mail acknowledging receipt of your enrollment request.
Individuals must have both Part A and Part B to enroll.
- Non-discrimination notice (PDF)
- Summary of Benefits
- Optional Supplemental Dental Benefits
- Plan star rating (PDF)
- Important contract information (PDF)
Resources for enrollment
Clackamas, Multnomah, Washington, and Yamhill counties in Oregon
Columbia, Lane, Marion, and Polk Counties in Oregon and Clark County in Washington
Crook, Deschutes, Hood, Jefferson, and Wheeler counties in Oregon
Benton and Linn counties in Oregon
Spokane county in Washington
Snohomish county in Washington
DSNP Area (Multnomah, Clackamas, and Washington counties in Oregon)
Medical Only No Rx area: Clackamas, Columbia, Lane, Marion, Multnomah, Polk, Washington, Yamhill counties in Oregon and Clark County in Washington
Optional supplemental benefit coverage for dental
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Webpage is current as of: 06/16/2021