Nascentia Health Plus Medicare Advantage I-SNP Enrollment (Virtual-Part 1)
The following Enrollment Form is to enroll in a Medicare Advantage Plan (Part C) with Medicare Prescription Drug Plan (Part D)
Last Updated on December 20, 2023
1-888-477-4663 (TTY: 711)
The following Enrollment Form is to enroll in a Medicare Advantage Plan (Part C) with Medicare Prescription Drug Plan (Part D)
Last Updated on December 20, 2023
Who can use this form?
People with Medicare and Medicaid who want to join a Medicare Advantage Plan
To join a plan, you must:
Important: To join a Medicare Advantage Plan, you must also have both:
When do I use this form?
You can join a plan:
Visit Medicare.gov to learn more about when you can sign up for a plan.
What do I need to complete this form?
Note: You must complete all items in Section 1. The items in Section 2 are optional — you can’t be denied coverage because you don’t fill them out.
Reminders:
What happens next?
Complete and submit the online enrollment form starting on the next page or download the enrollment application (pdf) and send your completed and signed form to:
Nascentia Health Plus
1050 West Genesee Street
Syracuse, NY 13204
Once they process your request to join, they’ll contact you.
How do I get help with this form?
Call Nascentia Health Plus at 1-888-477-0090 (TTY: 711).
Or call Medicare at 1-800-MEDICARE (800-633-4227). TTY users can call 1-877-486-2048.
En español: Llame a Nascentia Health Plus al 888-477-4663-/TTY 7 o a Medicare gratis al 800-633-4227 y oprima el 2 para asistencia en español y un representante estará disponible para asistirle.
Individuals experiencing homelessness
If you want to join a plan but have no permanent residence, a Post Office Box, an address of a shelter or clinic, or the address where you receive mail (e.g. Social Security checks) may be considered your permanent residence address.