header

Enroll

Enrolling in Security 65® is simple

If you need help completing the form, or if you have any questions concerning Security 65, just call our toll-free number 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week.

No premium payment is required at the time you apply.

Once your application has been processed, we will notify you of your effective date and we’ll send your Security 65 identification card, subscription agreement, and other important information.

Enroll by mail

Download the Security 65 application form.

An application (in PDF format) will open in a new window for you to download.

To view the application, you will need a “plug-in” for your browser or the Acrobat Reader software. For more information about PDFs and to download the free software, visit the Adobe Acrobat Reader website.

When you have completed the form, print it, sign it, and mail it to:

Security 65
Medicare Department
Independence Blue Cross
PO Box 7330
Philadelphia, PA 19101-8957

Disenrollment

You may disenroll from Security 65 by sending a written request to:

Security 65
Medicare Department
Independence Blue Cross
PO Box 7330
Philadelphia, PA 19101-8957