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Medicare 101

Next, enter some basic information in the fields below to reserve your spot.

Existing Highmark member?

Call 1-800-241-5704 to speak with member services.

Fields marked with an asterisk (*) are required.

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*Required First Name is required. Please enter only letters (A-Z, a-z) and characters including periods, apostrophes, spaces and hyphens (.' -)
*Required Last Name is required. Please enter only letters (A-Z, a-z) and characters including periods, apostrophes, spaces and hyphens (.' -)
*Required Address is required Please enter an address in the format: '123 Highmark Lane.'
*Required City is required. Please enter only letters (A-Z, a-z) and characters including periods, apostrophes, spaces and hyphens (.' -)
Please select a county
*Required Please enter your date of birth. Please enter a valid date of birth. Minimum age should be 18 years.

We’d like your phone number and email address so we can contact your about your reservation.

*Required Phone Number is required. Please enter a valid phone number.
*Required Email address is required. Please enter an email address in the format: 'email@example.com.'
*Required Please confirm your email address. Please enter an email address in the format: 'email@example.com.' Please enter an email that matches the previous field.

Please tell us when you would like for your coverage to begin:

Please select a coverage start date
Please agree to continue
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