Medicare 101

Next, enter some basic information in the fields below to reserve your spot.

Existing Highmark member?

Call 1-800-241-5704 to speak with member services.

Fields marked with an asterisk (*) are required.

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*Required Please enter your First Name Please enter only letters
*Required Please enter your Last Name Please enter only letters
*Required Please enter an address
*Required Please enter a city
Please select a county
*Required Please enter your date of birth. Please enter a valid date of birth. Minimum age should be 18 years.

We’d like your phone number and email address so we can contact your about your reservation.

*Required Please enter your phone number Please enter a valid phone number. Can't start with 0 or 1. Can't be in formats (111) 111-1111 and (111) XXX-XXXX
*Required Doesn't match with email address field

Please tell us when you would like for your coverage to begin:

Please select a coverage start date
Please confirm you are not a robot