How to Enroll
Thank you for your interest in becoming a member with Allwell from Home State Health. We are excited for you to join us!
There are three (3) ways to enroll:
Paper Application Instructions
- Download and print the paper application.
- Please fill out the paper application.
- Check either YES or NO box for items 1 through 5 on page 4.
- Enter your Primary Care Physician's name.
- Sign and date the enrollment application for Allwell on page 6.
- Check any box on page 8 that applies to you.
- Submit your application via mail or fax.
Paper Application Submission Options
Mail Your Application
Send your application to:
Medicare Enrollment Department
P.O. Box 2020
Farmington, MO 63640-2011
Fax Your Application
Fax your application to:
Look at 2018 information for plan details.