How to Enroll Online
Enrollment begins October 15
Use these step-by-step instructions to fill out the 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.
Provide the personal information requested. Please contact AmeriHealth Caritas VIP Care (HMO-SNP) if you need information in another language or format (such as large font, audio, or Braille).
Medicare insurance information
You will need your Medicare card to complete this section.
Your plan premium
Click on the circle next to the payment option you prefer.
Please answer all six questions in this section.
Select a primary care provider(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.
- To choose a PCP, click on the name of the provider you want to use. The name will be automatically filled in on your application form.
- Need help? Call 1-855-241-3648 (TTY/TDD 1-855-241-3649), 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 after 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 AmeriHealth Caritas VIP Care (HMO-SNP) member ID card.
If you need help
- Call us toll free at 1-855-241-3648 (TTY/TDD 711), seven days a week, 8 a.m. to 8 p.m.