Online Enrollment Welcome to the PacificSource Medicare Online Enrollment Center When you can enroll: When you become eligible for Medicare The Annual Enrollment Period: (October 15 – December 7) The Open Enrollment Period: (January 1 – March 31) If you are already enrolled in a Medicare Advantage plan Special Enrollment Periods: There are many other circumstances for which you could be eligible to enroll, outside these three periods. Dual special needs plans (D-SNP) have additional enrollment periods. Call us for details. We offer a variety of ways to enroll. You can complete an application online, or you can print the enrollment form and mail or fax it to us. If you would like to enroll by phone or receive enrollment forms by mail, please call us at 866-282-8814, TTY 711. By submitting an enrollment application, you are requesting enrollment with PacificSource Medicare. We then send your application to the Centers for Medicare & Medicaid Services (CMS) for approval. If CMS approves your application, you will be enrolled in the plan you selected. You will receive a confirmation notice and plan benefit information in the mail. If CMS denies your enrollment request, you will receive a notice in the mail telling you why your request was denied. Apply Online Change My Plan Print Enrollment Form Search Tools Drug Search Find a Doctor Find a Pharmacy Need Help? Contact Us PacificSource Medicare Website © 2021 - PacificSource Health Plans Last Updated: 10/1/2021 Y0021_EN3305 Language Help Asistencia con el idioma Trợ Giúp Ngôn Ngữ 語言協助 Языковая помощь 언어 도움말 Мовна Допомога 多言語ヘルプ المساعدة اللغوية Asistenţă lingvistică ជំនួយផ្នែកភាសា Gargaarsa Afaanii Sprachenhilfe خدمات پشتیبانی زبان و ترجمه Assistance avec la langue ภาษาช่วยเหลือ Medicare rules specify when your PacificSource Medicare coverage will be effective. Your actual plan effective date may be different from your requested effective date. PacificSource Community Health Plan is an HMO, HMO D-SNP, and PPO plan with a Medicare contract and a contract with Oregon Health Plan (Medicaid). Enrollment in PacificSource Medicare depends on contract renewal.