WPS Health Insurance WPS MedicareRx Plan (PDP) Individual Enrollment Form
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Start Your Information Medicare Information Payment Option Current Prescription Coverage Sign


Getting Started

Completing the application process on the next few pages will send an actual enrollment request to WPS and will be confirmed with the Centers for Medicare & Medicaid Services (CMS).

Start a New Application
To begin a new application, agree to the statement below and click the Start New Application button:
I have reviewed the WPS MedicareRx Plan pre-enrollment materials. If you have not yet reviewed these materials, click here and review the information on the WPS MedicareRx Plan Web site.

Finish My Saved Application
Application number:
For security, only you know your application number. If you do not have it, please start a new application.
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S5753_APP_1707E
CMS Approved
Last Updated on 10/01/2017