You’ve looked at your options, and now you’re ready to enroll. We want to make the process as easy as possible for you. This section outlines your four EmblemHealth Medicare Advantage Plan enrollment options. Members may enroll in the plan only during specific times of the year.

Below are your four EmblemHealth Medicare Advantage Plan enrollment options.


If you’ve already selected a plan, you can enroll with us online by clicking the enroll online button below. You can also enroll in an EmblemHealth Medicare Advantage Plan through the Centers for Medicare & Medicaid Services Online Enrollment Center at


In-Home Appointment

You can schedule an appointment with an EmblemHealth Sales Representative who will answer your questions and help you complete the enrollment application.

Attend a seminar

You can visit one of our convenient Medicare seminars during the annual election period (AEP).

Call us at 800-447-9169 (TTY:711), 8 am to 8 pm, seven days a week to make an appointment or if you have questions about a seminar in your area.

By Phone

Medicare beneficiaries may enroll in an EmblemHealth Medicare Advantage Plan over the phone by calling us toll-free at 800-447-9169, 7 days a week, 8 am to 8 pm (TTY:711).

By Mail

You can download the enrollment form below, complete it and send it to us. We will confirm we received your application by mail.

Download EmblemHealth Medicare Advantage Enrollment Forms below.

2019 EmblemHealth Medicare Advantage Application for all VIP Plans except EmblemHealth VIP Dual (HMO SNP)

English  |  Español  |  中文


2019 EmblemHealth Medicare Advantage Application for EmblemHealth VIP Dual (HMO SNP) 

English  |  Español  |  中文


2019 EmblemHealth Affinity Medicare Application

English  |  Español  |  中文


Mail your enrollment form to:

Attention: Medicare Marketing
P.O. Box 2859
New York, NY 100117-7894

To join an EmblemHealth Medicare plan, you must:

  • Qualify and be enrolled in Medicare Part A (you are 65 or older, or under 65 with certain disabilities); and
  • Be enrolled in and continue to pay for Medicare Part B; and
  • Live in EmblemHealth’s service area for that plan; and
  • Not have End-Stage Renal Disease (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances.


View EmblemHealth's 2019 Service Area maps which include the following counties in New York: Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland Suffolk, Sullivan, Westchester and Ulster. Download PDF


2019 EmblemHealth HMO Medicare Service Area Map

Download PDF:  English  |   Español   |   中文


Initial Coverage Election Period

You can enroll when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.

Medicare beneficiaries may enroll only during specific times of the year. Visit our Medicare Enrollment Periods page to see the best time to enroll and other details about enrollment timelines.

What happens after I enroll?

We will mail you a letter confirming that we received your application. After that, we will send your application to the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs the Medicare program, for approval.

When am I officially an EmblemHealth member?

You should get your EmblemHealth member ID card and Welcome Kit in the mail about seven business days after you receive our confirmation letter. An EmblemHealth Customer Service Representative will also call you to answer your questions and help you under stand your benefits. During one of these calls, you will be asked some questions about your health. This is because CMS asks all Medicare Advantage plans to do a Health Risk Assessment (HRA) for members. It will not affect your membership in EmblemHealth in any way. And your answers may help EmblemHealth to serve you better.

Last Updated 10/01/19

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