Does NOT cover Part B deductible
(Must reside in Rock, Green or Jefferson County)
*Applications and 2 months' premium must be received by MercyCare Sales Department by the 25 of each month for the upcoming month.
- Premiums
- Outline of coverage
- Policy
- Provider Directory
The Provider Directory (hard copy) is updated annually. For an up-to-date list of providers, please use our "Find a Doctor" search tool, which is updated monthly.
Forms and documents
- Application
- Voluntary discontinuation of coverage
- Stay healthy form
- Auto withdrawal form
- Agent statement - to be completed by agent if assisting in process
- Guide to health insurance for people with Medicare in Wisconsin