Below are your four EmblemHealth Medicare Advantage Plan enrollment options.
Online
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 Medicare.gov.
For 2021 plans, you will be able to enroll online on October 15.
Make a Face to Face 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
Explore your options during the Annual Election Period (AEP) with a virtual seminar, led by a Medicare expert.
- Learn all about Medicare from the comfort of home
- Find a virtual seminar day and time that works for you
We also have in-person seminars at select locations where we can arrange a safe experience.
Find an in-person seminar near you.
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, (TTY: 711) seven days a week, 8 am to 8 pm.
By Mail
You can download a Medicare Advantage, enrollment form below for the plan you want to enroll in, complete it and send it to us. We will confirm we received your form by mail.
2021 EmblemHealth Medicare Advantage (HMO) Enrollment Form for all VIP Plans except EmblemHealth VIP Dual plans and Capital Region
English | Español | 中文
2021 EmblemHealth Medicare (HMO) Advantage Enrollment Form for all Capital Region plans (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and, Washington)
English | Español | 中文
2021 Optional Supplemental Benefit Form (dental and fitness) for members of VIP Part B Saver and VIP Value plans.
English | Español | 中文
2021 EmblemHealth Medicare Advantage Enrollment form for EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Select (HMO D-SNP) and EmblemHealth VIP Solutions (HMO D-SNP) and VIP Dual Reserve (HMO D-SNP)
English | Español | 中文
2021 EmblemHealth Prescription Drug Plan (PDP) Enrollment Form for VIP Rx (PDP) and EmblemHealth VIP Rx Plus (PDP) Medicare 2020 EmblemHealth VIP Rx (PDP) and EmblemHealth VIP Rx Plus (PDP) Medicare Application
English | Español | 中文
2020 EmblemHealth Medicare Advantage Application for all VIP Plans except EmblemHealth VIP Dual (HMO D-SNP) and Capital Region
English | Español | 中文
2020 EmblemHealth Medicare Advantage Application for all Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and, Washington)
English | Español | 中文
2020 Optional Supplemental Benefit Form (dental and fitness) for members of VIP Part B Saver and VIP Value plans.
English | Español | 中文
2020 EmblemHealth Medicare Advantage Application for EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Select (HMO D-SNP) and EmblemHealth VIP Solutions (HMO D-SNP)
English | Español | 中文
2020 EmblemHealth VIP Rx (PDP) and EmblemHealth VIP Rx Plus (PDP) Medicare Application
English | Español
Mail your enrollment form to:
EmblemHealth Medicare
P.O. Box 4001
Farmington, Connecticut 06034-9900