How do you enroll in Molina Medicare Complete Care (HMO SNP) plan?

Please follow the instructions and complete the Enrollment Form, today.
We encourage you to read the Summary of Benefits before completing an Individual Enrollment Request form.

2020 Online Enrollment Form

icon PDF 2020 Enrollment Instructions

icon PDF 2020 Enrollment Form (Los Angeles, Riverside, San Bernardino and San Diego) 

icon PDF 2020 Enrollment Form (Imperial) 


2021 Online Enrollment Form

icon PDF 2021 Enrollment Instructions

icon PDF 2021 Enrollment Form 


Following Steps 1 – 5 of the Enrollment Instructions PDF above will assist you with the enrollment process.

If you need help completing this enrollment form or prior to enrollment have questions about plan benefits, please call us Toll Free: (866) 403-8293, TTY/TDD: 711, Monday to Saturday, 8:00 a.m. to 8:00 p.m. local time. Molina Medicare determines when your Enrollment Form is considered to be complete based on Medicare enrollment guidelines. The Enrollment Form is subject to approval from CMS. If your enrollment is not accepted by CMS, we will notify you immediately.


CMS Medicare Online Enrollment Center

Medicare beneficiaries may also enroll in the Molina Medicare Complete Care (HMO SNP) plan through the CMS Medicare Online Enrollment Center located at


*Printed copies of information posted on our website are available upon request. 

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