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Contact Us To Schedule an Appointment
  585-601-5000
  Mon-Thurs 10:00am - 4:00pm

Applications and Forms

 

MEDICARE PART B

Part B Individual Enrollment Form (CMS 40B)

Get Started

MEDICARE PART B

Part B Request for Employment Information (CMS L564)

Get Started

IRMAA

Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

Get Started

 

MEDICARE SAVINGS PROGRAM

Medicare Savings Program Application

Get Started

APPOINTMENT OF REP

Medicare Appointment of Representative form

Get Started

EPIC

EPIC Application

Get Started

 

FINANCIAL ASSISTANCE

Rochester Regional Health Financial Assistance Application

Get Started

FINANCIAL ASSISTANCE

University of Rochester Financial Assistance Application

Get Started

PART A & B

Request For Termination of Medicare

Get Started

 

Office Locations

Find a Rochester NY Location Near You

 

East Side Location:

70 Linden Oaks Dr. Ste. 300
Rochester, NY 14625

 585-601-5000

 

West Side Location:

2800 Dewey Avenue
Rochester, NY 14616

 585-601-5000

 

During the Medicare Annual Enrollment Period
of October 15th – December 7th, we have two additional locations:
By Appointmen Only

 

Coming Soon

 

Churchville Location:

By Appointment Only

42 S. Main St. Suite F
Churchville, NY 14428

 585-685-2089