You may enroll in Plan 65 if you have a qualifying event or your application is approved by our Medical Underwriting Department. Otherwise, you may enroll in Plan 65 A from October 15 to December 7 for coverage starting in January.
If you are already enrolled in Plan 65, please call Customer Service at 1-800-639-2227.
ARE YOU NEW TO PLAN 65?
Apply by fax or U.S. mail
- Click on the Plan 65 Application form, save it to your computer by clicking File and then Save on your internet browser.
Plan 65 Application
- Are you new to Medicare or have a qualifying event?
If yes, you can SKIP this step and go to Step 3.
- Type your information directly onto the form. Save again when you're done entering your information.
- Print the form, then mail or fax it to Blue Cross & Blue Shield of Rhode Island using the instruction sheet below.
Where to send Plan 65 forms
Apply in person at Providence walk-in area at 500 Exchange St.