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3. Mail

Start by downloading the appropriate application below:

2022 Capital District/Southern Tier/Central New York Region Application (PDF)
(Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Columbia, Cortland, Delaware, Dutchess, Fulton, Greene, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Orange, Oswego, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Schuyler, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, and Westchester counties)

2022 Hudson Valley Region Application (PDF)
(Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester counties)

2022 Rochester / Buffalo Region Application (PDF)
(Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Wayne, Wyoming and Yates counties)

2022 Patriot Plan PPO Application (PDF)
(Albany, Allegany, Cattaraugus, Chautauqua, Dutchess, Erie, Genesee, Jefferson, Livingston, Monroe, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Putnam, Rensselaer, Rockland, St. Lawrence, Saratoga, Schenectady, Seneca, Steuben, Ulster, Wayne, Westchester, Wyoming, and Yates counties)

2022 MVP DualAccess HMO D-SNP Application (PDF)
(Albany, Columbia, Dutchess, Greene, Orange, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Sullivan, Ulster, and Westchester counties)

2022 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)

2022 Vermont/Northern New York (PDF)
(Addison, Bennington, Caledonia, Chittenden, Essex, Franklin, Grand Isle, Lamoille, Orange, Orleans, Rutland, Washington, Windham, and Windsor counties in Vermont; Clinton, Essex, Franklin, Hamilton, and St. Lawrence counties in New York)

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 Enrollment
   MVP Health Care
   220 Alexander St.
   Rochester, NY 14607