Enroll today!

When you join Molina Medicare, you can be sure your individual needs are met.

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.

Enroll online

icon PDF 2022 Online Enrollment Form

icon PDF 2021 Online Enrollment Form

Enroll by mail

icon PDF 2022 Enrollment Form

Mail to:
         Molina Healthcare, Inc.
         Attn: Enrollment Accounting
         PO BOX 22800
         Long Beach, CA 90801-9945


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 Complete Care (HMO SNP) plan through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
 *Printed copies of information posted on our website are available upon request.


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