Application Forms

Application Process


Effective January 1, 2014 WSHIP is only accepting applications for its Medicare-eligible plan (Basic Plan). The Basic Plan provides secondary coverage for qualified individuals enrolled in Medicare Parts A and Part B who live in a county without a reasonable choice of Medicare Advantage Plans. Click Here to learn more about eligibility requirements for the Basic Plan.

Individuals not eligible for Medicare may purchase coverage from the Washington Healthplanfinder at or buy directly from an insurance company during defined open enrollment periods. You can’t be turned down for pre-existing conditions. Click Here to learn about Washington Healthplanfinder.

The WSHIP application process is as follows:

           2019 Medicare Enrollment Packet  

  1. Complete the WSHIP application form ( 2019 Medicare Basic Plan Application )

  2. If you have any questions while completing the application, please contact our Customer Service Department at 1-800-877-5187.

  3. Once your application is approved and we have received your first premium payment, we will send you an identification card and your insurance policy. The insurance policy provides specific details of your plan's benefits and the procedures you need to follow in order to get the maximum benefits to which you are entitled.

Mail your completed application to WSHIP at the address below or fax it to 620-793-1199.