Enrollment Application 2022

Click here for 2021 Enrollment Application

You can enroll in a Preferred Care Partners plan RIGHT NOW by doing the following:

1. Download, print and complete form with signature:

Enrollment Application

• Preferred Choice Dade (HMO)
• Preferred Choice Broward (HMO)
• Preferred Choice Palm Beach (HMO)

Application Instructions 

Instructions for plans above

Plan Recap

Enrollment Application

• Preferred Special Care Miami-Dade (HMO C-SNP)

Application Instructions

Instructions for Preferred Special Care Miami-Dade (HMO C-SNP)

Plan Recap

If you are enrolling in Preferred Special Care Miami-Dade (HMO C-SNP), you must fill out the Chronic Condition Pre-Assessment Form.

Click here to download the Chronic Condition Pre-Assessment Form.

Enrollment Application

• Preferred Medicare Assist Plan 1 (HMO D-SNP) 
• Preferred Medicare Assist Palm Beach (HMO D-SNP)
• Preferred Medicare Assist Plan 2 (HMO D-SNP)

Application Instructions

Instructions for plans above

Plan Recap

Need Assistance Completing This Form?

	Preferred Choice Dade (HMO)   Preferred Choice Broward (HMO)                                 1-844-723-6470   (TTY 711)   Preferred Choice Palm Beach (HMO)                            toll free  Preferred Special Care Miami-Dade (HMO C-SNP) 1-855-548-1564 (TTY 711) toll free
	1-888-950-1170
	Preferred Medicare Assist Plan 1 (HMO D-SNP)                        Preferred Medicare Assist Palm Beach (HMO D-SNP)       1-855-874-6282 (TTY 711)  Preferred Medicare Assist Plan 2 (HMO D-SNP)                 toll free
	1-888-950-1169
	Open  8 a.m. to 8 p.m.    7 days a week, including holidays

OR:

2. Enroll online by completing and submitting your enrollment form electronically!

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