Request Medicare kits

Fields with an asterisk (*) are required and must be filled out to process your request.

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How many of each kit would you like to have mailed to you?
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Would you like us to email you forms or kits?

When you submit this information to Fallon Health, the transmission will be sent using encryption security. However, to protect your privacy, and the privacy of our members, please do not use unencrypted email to communicate confidential information, including information about our members. If you have questions about secure communications, please contact a customer service representative at 1-800-868-5200 (TRS 711).