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.
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?