How do you enroll in Molina Medicare Choice Care (HMO) 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.

2021 Online Enrollment Form

icon PDF2021 Enrollment Instructions

icon PDF2021 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 have questions about plan benefits prior to enrollment, 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 is subject to approval from the Centers for Medicare & Medicaid Services (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 Choice Care (HMO) 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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