Medicare Part D Plan Forms & Information | AARP® Medicare Plans from UnitedHealthcare®

Prescription Drug Plans

Plan Information and Forms

Find helpful prescription drug plan resources including forms, plan materials and more.

Note: PDF (Portable Document Format) files can be viewed with Adobe® Reader®. If you don't already have this viewer on your computer, download it free from the Adobe website.

My account

Sign in to view details about your coverage. When you sign in, you can track and manage your spending to date, including your total drug costs and out-of-pocket costs. You can also print a temporary member ID card or order a replacement member ID card, among other tasks. If you don't have an account, please register.

Mail-order forms

Enrollment forms

To get an AARP MedicareRx Plans insured through UnitedHealthcare enrollment form (PDF), go to View plans and pricing and enter your ZIP code. Choose one of the available plans in your area and view the plan details. You'll find the form you need in the Helpful Resources section.

Payment and reimbursement forms

Authorization forms

Other forms and plan materials

To request disenrollment from your Medicare prescription drug plan and switch to Original Medicare only, you have two options. You can either complete the Online Disenrollment Form electronically or download the Disenrollment Form (PDF), then follow the directions on that form to complete it and return it by mail or fax.

Find Medicare Prescription Drug Plans in Your Area

Example: 55105
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