3. Mail

Start by downloading the appropriate application below:

2019 Capital District / Southern Tier Region Application (PDF)
(Albany, Broome, Cayuga, Chemung, Chenango, Columbia, Cortland, Delaware, Essex, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Schuyler, Steuben, Tioga, Tompkins, Warren and Washington counties)

2019 Central New York Application (PDF)
(Herkimer, Jefferson, Madison, Oneida, Onondaga, Oswego, and Otsego counties)

2019 Vermont Region Application (PDF)
(Addison, Bennington, Caledonia, Chittenden, Essex, Franklin, Grand Isle, Lamoille, Orange, Orleans, Rutland, Washington, Windham, and Windsor counties)

2019 Hudson Valley Region Application (PDF)
(Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties)

Solicitud para la Región del Valle de Hudson 2019 (PDF)
(Condados de Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster y Westchester)

2019 Rochester / Buffalo Region Application (PDF)
(Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Wayne, Wyoming and Yates counties)

2019 SmartFund MSA Application (PDF)
(Albany, Broome, Cayuga, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Orange, Oswego, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, St. Lawrence, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington and Westchester counties only)

Once you’ve downloaded the application, follow these simple instructions:

1. Select your plan choice on the application.
2. Be sure to fill out one application for each person enrolling.
3. Sign and date the application(s).
4. Send your completed application(s) to:
   
   MVP Health Care
   MVP Medicare Sales
   220 Alexander St.
   Rochester, NY 14607