Become a Member

Enroll Online Now with HealthTeam Advantage 2023

The fastest, easiest way to enroll is to use our online enrollment form:

Enroll in a 2023 Plan

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Enrollment Instructions

Who can use this form?

People with Medicare who want to join a Medicare Advantage Plan.
To join a plan you must:

  • Be a United States citizen or be lawfully present in the U.S.
  • Live in the plan’s service area.

Important: You must also have Medicare Part A and Part B.

When do I use this form?

You can join a plan:

  • Between October 15–December 7 each year (for coverage starting January 1) 
  • Within 3 months of first getting Medicare
  • In certain situations where you're allowed to join or switch plans.

Visit Medicare.gov to learn more about when you can sign up for a plan.

What do I need to complete this form?
  • Your Medicare Number (the number on your red, white, and blue Medicare card)
  • Your permanent address and phone number

Note: You must complete all items in Section 1.
The items in Section 2 are optional—you can't be denied coverage because you don't fill them out.

How do I get help with this form?

Call HealthTeam Advantage at 877-905-9216.
TTY users can call 711.

Or, call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

En español: Llame a HealthTeam Advantage al 877-905-9216 / TTY 711 o a Medicare gratis al 1-800-633-4227 y oprima el 2 para asistencia en español y un representante estará disponible para asistirle.

Enroll Online Now

Enroll in a 2023 Plan