Enroll in or change your health plan and primary care provider

Welcome to the Health Plan Enrollment Form!

You can use this form to choose and change the MassHealth health plan and primary care provider that best fits you or your family's health care needs. To learn more about your available choices, go to MassHealth Choices

If you wish to make enrollment changes for other individuals in your household, you will need to complete a form for each MassHealth member.

Is this form right for you?

Only MassHealth members, Authorized Representative Designees, Parents or Guardians, or Massachusetts Navigators can submit this form. Are you filling out this form for yourself or someone else?

Select who is filling out this form

Certain members in the MassHealth program will need to enroll in a health plan. Use this form to choose your MassHealth health plan if you :

Are under 65
Live in a community (for example, not in a nursing facility), and
Are in MassHealth Standard, CommonHealth, CarePlus, or Family Assistance.

This is NOT an application to apply for MassHealth. If you need to apply for MassHealth, go to MA Health Connector