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Welcome to the PacificSource Medicare Online Enrollment Center


When you can enroll:

  • When you become eligible for Medicare
  • The Annual Enrollment Period: (October 15 – December 7)
  • The Open Enrollment Period: (January 1 – March 31) If you are already enrolled in a Medicare Advantage plan
  • Special Enrollment Periods: There are many other circumstances for which you could be eligible to enroll, outside these three periods.
  • Dual special needs plans (D-SNP) have additional enrollment periods. Call us for details.

We offer a variety of ways to enroll. You can complete an application online, or you can print the enrollment form and mail or fax it to us. If you would like to enroll by phone or receive enrollment forms by mail, please call us at 866-282-8814, TTY 711.

By submitting an enrollment application, you are requesting enrollment with PacificSource Medicare. We then send your application to the Centers for Medicare & Medicaid Services (CMS) for approval. If CMS approves your application, you will be enrolled in the plan you selected. You will receive a confirmation notice and plan benefit information in the mail. If CMS denies your enrollment request, you will receive a notice in the mail telling you why your request was denied.

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