How to Enroll Online

Use these step-by-step instructions to fill out the enrollment form.

Enrollment form

Go to the enrollment form page. Enter your ZIP code in the box. Click Go To Enrollment Form.

Choose a plan

Pick the Medicare Advantage plan you want to join.

Personal information

Provide the personal information requested. Please contact Keystone First VIP Choice (HMO-SNP) if you need information in another language or format (such as Braille).

Medicare insurance information

You will need your Medicare card to complete this section.

Important questions

Please answer all six questions in this section.

Select a primary care physician (PCP), clinic, or health center from our provider network

• To find a PCP, click Please Choose a Primary Care Physician. This will take you to the Online Provider Directory. Use this tool to find a PCP in your area.
• To choose a PCP, click on the name of the doctor you want to use. The name will be automatically filled in on your application form.
• Need help? Call 1-855-241-3648 (TTY 711), seven days a week, 8 a.m. to 8 p.m.

Authority to sign application

Please check the circle next to the statement that applies to you.

Submit enrollment form

• Click Enroll Now to send in your enrollment form.
• You will receive a confirmation number that we have received your form. Please make a note of this number for your reference.
• Once your enrollment is accepted by the Centers for Medicare & Medicaid Services (CMS), we will send your new member materials, including your Keystone First VIP Choice member ID card.

If you need help

Call 1-855-241-3648 (TTY 711), seven days a week, 8 a.m. to 8 p.m. Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31