Enroll today!

When you join Passport Health Plan Medicare, you can be sure your individual needs are met.

Please follow the instructions and complete the Enrollment Form, today. We encourage you to read the Summary of Benefits before completing an Individual Enrollment Request form.

Enroll online

2022 Online Enrollment Form

Enroll by mail

icon PDF 2022 Enrollment Form

Mail to:

         Passport Health Plan

         Attn: Enrollment 

          5100 Commerce Crossings Dr

          Louisville, KY 40229


If you need help completing this enrollment form or have questions about plan benefits prior to enrollment, please call us Toll Free:
(844) 643-2780, TTY 711, Monday to Sunday, 8 a.m. to 8 p.m., local time. Passport Health Plan determines when your Enrollment Form is complete based on Medicare enrollment guidelines. The Enrollment is subject to approval from the Centers for Medicare & Medicaid Services (CMS). If your enrollment is not accepted by CMS, we will notify you immediately.

CMS Medicare Online Enrollment Center

Medicare beneficiaries may also enroll in the Passport Medicare plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.