Paying Your Monthly Premium is Easy

If you’ve selected a MediGold plan with a monthly premium, your payment must be received by the 10th day of each month. There are three easy ways to pay.

  1. Electronic Funds Transfer
    Your payment is automatically withdrawn from a designated bank account. Access the form above or download the form here.
  2. Social Security Withdraw
    Your payment is automatically withdrawn from your Social Security check. Simply complete this form to change to this option.
  3. Billing Statements
    Receive a monthly billing statement and have your check to MediGold by the 10th of each month.


You can change your payment method at any time. If you need assistance, please call Member Services:

1-800-240-3851 (TTY 711)

Updated  01/2020