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Enrollment Forms and Instructions

To enroll by mail: Download the enrollment form for your desired Bravo Health plan by clicking on the service area. Print out the enrollment form, complete it and mail it to Bravo Health at:

Bravo Health

Attn: Sales Department

3601 O'Donnell Street

Baltimore, MD 21224

Bravo Health Plan Service Area
Bravo Classic District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
Pennsylvania: Allegheny, Bucks, Cumberland, Delaware, Lancaster, Montgomery, Philadelphia, Washington, Westmoreland, York
Bravo Classic Plus New Jersey: Camden, Gloucester
Texas: Bexar, Chambers, Collin, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Liberty, Montgomery, Tarrant
Bravo Gold District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
Bravo Premier Pennsylvania: Allegheny, Bucks, Delaware, Montgomery, Philadelphia, Washington, Westmoreland
Bravo Premier Plus District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
New Jersey: Camden, Gloucester
Bravo Select District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
Pennsylvania: Allegheny, Bucks, Cumberland, Delaware, Lancaster, Montgomery, Philadelphia, Washington, Westmoreland, York
Texas: Bexar, Chambers, Collin, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Liberty, Montgomery, Tarrant
Bravo Silver New Jersey: Camden, Gloucester
Bravo Traditions District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
New Jersey: Camden, Gloucester
Pennsylvania: Allegheny, Bucks, Cumberland, Delaware, Lancaster, Montgomery, Philadelphia, Washington, Westmoreland, York
Texas: Bexar, Collin, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Liberty, Montgomery, Tarrant
Bravo Freedom District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Montgomery, Prince George's
Pennsylvania: Cumberland, Lancaster, York
Texas: Bexar, Chambers, Collin, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Liberty, Montgomery, Tarrant
Bravo Liberty I Texas: Atascosa, Bexar, Chambers, Collin, Dallas, Galveston, Harris, Jefferson, Johnson, Liberty, Medina, Montgomery, Orange, Rockwall
Bravo Liberty II RX Delaware: Kent, New Castle, Sussex
District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Dorchester, Harford, Howard, Prince George's
Texas: Atascosa, Bexar, Brazoria, Chambers, Collin, Dallas, Denton, El Paso, Ellis, Fort Bend, Galveston, Guadalupe, Harris, Jefferson, Johnson, Liberty, Medina, Montgomery, Orange, Parker, Rockwall
Bravo Liberty Silver Texas: Atascosa, Bexar, Brazoria, Chambers, Collin, Dallas, Denton, El Paso, Ellis, Fort Bend, Galveston, Guadalupe, Harris, Jefferson, Johnson, Liberty, Medina, Montgomery, Orange, Parker, Rockwall
Senior Partners Gold Pennsylvania: Bucks, Montgomery, Philadelphia
Senior Partners Gold Rx Pennsylvania: Bucks, Montgomery, Philadelphia
Senior Partners Silver Pennsylvania: Bucks, Montgomery, Philadelphia
Bravo Choice Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
Bravo Achieve District of Columbia: Washington, D.C.
Maryland: Anne Arundel, Baltimore City, Baltimore County, Maryland, Harford, Howard, Montgomery, Prince George's
New Jersey: Camden, Gloucester
Pennsylvania: Allegheny, Bucks, Cumberland, Delaware, Lancaster, Montgomery, Philadelphia, Washington, Westmoreland, York
Texas: Bexar, Chambers, Collin, Dallas, Denton, El Paso, Fort Bend, Galveston, Harris, Liberty, Montgomery, Tarrant
BravoRx Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, Wisconsin, Wyoming
You may be able to get Extra Help to pay for your prescription drug premiums and costs.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy five (75) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227).
    TTY users should call 1-877-486-2048, 24 hours a day/7days a week;

  • The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday.
    TTY users should call, 1-800-325-0778; or

  • Your State Medicaid Office

The Federal Government has established periods when a person can join and change their Medicare prescription drug coverage. Unless you qualify for a special election period, you can change Medicare prescription drug plans once a year between November 15th and December 31st.

Medicare beneficiaries may be enrolled in only one Part D plan at a time. If you are enrolled in a Medicare Advantage (MA) coordinated care (HMO or PPO) plan or a Medicare Advantage Private-Fee-for-Service plan (PFFS) that includes Medicare Prescription Drugs, you may not enroll in a stand a lone Prescription Drug Plan unless you disenroll from the HMO, PPO, or MA PFFS plan. If you are enrolled in a Private Fee-for-Service plan that does not provide Medicare Prescription Drug coverage, or an MA Medical Savings Account (MSA) plan you may enroll in a PDP.

Eligible beneficiaries must use network or contracted pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies. Bravo Health's mail-order service requires you to order at least a 31-day supply of the drug and no more than a 90-day supply. To get order forms and information about filling your prescriptions by mail, contact Member Services. If you use a mail order pharmacy not in the plan's network, your prescription will not be covered.

You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Bravo Health will be responsible for the costs. For full information on Bravo Health benefits, call our Member Services Department at 1-866-442-7498.

Plans are offered by Bravo Health, Inc., 3601 O'Donnell Street, Baltimore, Maryland 21224, Bravo Health Pennsylvania, Inc., Bravo Health Mid-Atlantic, Inc., Bravo Health Texas, Inc., and/or Bravo Health Life Insurance Company, Inc. Coverage is provided through a Medicare Advantage organization or a Medicare prescription drug plan sponsor with a Medicare contract. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year.

For assistance with Medicare Advantage Health Plans please call our Member Services Department at:

  • 1-800-291-0396 / TTY 1-800-964-2561.

  • Seven days a week, 8 am - 8 pm.

For assistance with stand alone Prescription Drug Plans please call our Member Services Department at:

  • 1-877-504-7252 / TTY 1-800-964-2561.

  • Seven days a week, 8 am - 8 pm.