Kaiser Permanente Medicare Health Plan Enrollment Survey

Tell us your plans.

With the information you provide from this survey, we’ll be able to schedule the right time to send you the materials you’ll need to enroll in a Kaiser Permanente Medicare health plan.

When you’re ready to enroll, we’ll guide you through the process and answer any questions you have. All that’s needed to get started is your timing.

Please fill out the information below so we can be in touch with you at the right time.

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There are errors in the following fields:

* = Required

*First Name

Error: Enter your first name

*Last Name

Error: Enter your last name

*Health/Medical Record number

Error: Enter your Health/Medical Record Number
Error: Enter a valid Health/Medical Record Number

*Select region

Error: Select a region

*When do you plan on enrolling in a Kaiser Permanente Medicare health plan? I plan to enroll in less than 3 months from today.
I plan to enroll in 3-6 months from today.
I plan to enroll in 6-12 months from today.
I plan to enroll in a year or more from today.
I plan to enroll in (select date):

Month

Error: Select a month

Year

Error: Select a year

Error: Select when you plan to enroll
Error: Enter a valid enrollment month and year

We're here to help

Call a Kaiser Permanente Medicare specialist toll free 6 a.m. to 7 p.m., Monday through Friday.

1-877-560-8672 (TTY 711)

Medicare nondiscrimination notice | Language assistance

You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll.

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This page was last updated: October 1, 2022 at 12 a.m. PT