Banner Medicare 2023 Enrollment Form Update

As a reminder, Banner Medicare has shifted to a new paper enrollment form to comply with new requirements from Medicare. Only the new form may be used for enrollment signature dates beginning in January. 

The new form has two additional questions in Section 2 for Race/Ethnicity that the current enrollment form does not have.

Since Banner Medicare's enrollment forms are not printed as part of the pre-enrollment kit, please remove and discard the prior version and replace it with the new version. 

Things to remember:

  • The new enrollment form is the only compliant enrollment form for signature dates beginning 1/1/2023 (New form includes Race/Ethnicity questions, old form does not)
  • The enrollment form can be downloaded from the Evolve shopping cart or emailed by contacting broker support or your ESR (we have also attached them here)
  • Enrollments submitted using the incorrect enrollment form will be automatically denied, and the correct enrollment form would need to be completed and submitted
  • All approved digital enrollment platforms (Evolve, Ascend, Connecture & Sunfire) are compliant with Banner Medicare enrollment form requirements at all times
  • Be sure to remove and replace the enrollment form in your remaining supply of pre-enrollment kits on January 1st
  • All pre-enrollment kit orders placed beginning December 20th include the new enrollment form

If you have any questions, call us today at 866-568-9649!


Main Office:
2401 Sardis Road North, Suite 110
Charlotte, NC 28227

Texas Office:
9441 Lyndon B. Johnson Fwy Suite 512
Dallas, TX 75243

Mississippi P&C Office:
180 Canal Place
Philadelphia, MS 39350

Helping Talented Agents Close More Sales

Follow Us: