Enroll Now
Follow these easy steps to become a Trinity Health Plan New York member.
Confirm you live in the service area
You must live in the Trinity Health Plan New York service area to be eligible to join our plan. Trinity Health Plan New York is currently available in select counties in New York. Visit the Service Area page for a complete list of covered counties.
Have your Medicare card ready
You will need your red, white and blue Medicare card to complete the enrollment form. Fill in the information exactly as it appears on your Medicare card.
Complete and submit your enrollment form
Choose the appropriate enrollment application below based on when you want your coverage to start. Complete all required sections of the form, and carefully review your selections before submitting. Complete one form per applicant.
Call us if you have questions
If you have questions or need assistance with your application, you can call 1-866-500-5797 (TTY: 711) to speak with a licensed Trinity Health Plan New York sales agent. Agents are available daily from 8 a.m. to 8 p.m. to assist you.
Prefer to fill out a paper application?
You can download and print a PDF copy of the Trinity Health Plan New York enrollment form. Please print legibly and complete all sections of the form. Remember to sign and date your enrollment form before submitting.
2025 Individual Enrollment Application
2024 Individual Enrollment Application
Then mail your completed and signed form to:
ATTN Enrollment
Medicare Health Plan
PO BOX 6111
Westerville, OH 43086-9874
Please make sure that all pages of the form are included.
Medicare beneficiaries may also enroll in Trinity Health Plan New York through the CMS Medicare Online Enrollment Center located at www.medicare.gov.