It’s Easy to Apply for the NEA Medicare
Supplement Program

Request a printed enrollment kit or print materials right from here!

Mail me a Personalized Enrollment Kit

Print Out an Enrollment Kit (.pdf, 3.7M)
Rates not included in this version. However, you can find your rate here.
(If you just need the application form, see below.)

Main Application (.pdf, 31K)
Complete this form for all Plan Options.

Automatic Payment (.pdf, 33K)
Pre-authorized check payment form for payment from your checking account.

Authorization for Electronic Claims Payment (.pdf, 12K)
Complete this form when you enroll to set up paperless claims processing for your Medicare Part B expenses.

FRS Form (.pdf, 561K)
Florida Residents: To pay via deductions from your Florida Retirement System pension check.

Find the cost of Medicare Supplement Programs for your state.

Enclose the appropriate forms in an envelope and mail to:

NEA Insurance Operations
P.O. Box 9186
Des Moines, IA 50306-9186