3. Mail
Start by downloading the appropriate application below:
2021 Capital District/Southern Tier/Central New York, Vermont Region Application (PDF)
(Addison, Albany, Allegany, Bennington, Broome, Caledonia, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Chittenden, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Grand Isle, Greene, Hamilton, Herkimer, Jefferson, Lamoille, Lewis, Madison, Montgomery, Oneida, Onondaga, Orange, Orleans, Oswego, Otsego, Rensselaer, Rutland, Saratoga, Schenectady, Schoharie, Schuyler, St. Lawrence, Steuben, Tioga, Tompkins, Warren, Washington, Windham, and Windsor counties)
2021 Hudson Valley Region Application (PDF)
(Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties)
Solicitud para la Región del Valle de Hudson 2021 (PDF)
(Condados de Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster y Westchester)
2021 Rochester / Buffalo Region Application (PDF)
(Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Wayne, Wyoming and Yates counties)
2021 SmartFund MSA Application (PDF)
(Albany, Allegany, Broome, Cattaraugus, 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:
- Select your plan choice on the application.
- Be sure to fill out one application for each person enrolling.
- Sign and date the application(s).
- Send your completed application(s) to:MVP Health Care
MVP Medicare Sales
220 Alexander St.
Rochester, NY 14607
