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CBC Medicare PPO Redirect

Have this information on hand to complete your enrollment application

Your red, white, and blue Medicare card.
If you need any assistance completing this application, please call us at 800.990.4201 (TTY: 711).

Required fields are noted with an asterisk *.

* Please select the option that best describes you

* County of residence

* Effective date

* Plan type

Medicare beneficiaries may also enroll in Capital Blue Cross PPO/HMO through the CMS Online Enrollment Center located at http://www.medicare.gov.

Updated February 27, 2025

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