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.

2020 Online Enrollment Form

icon PDF 2020 Molina Medicare Choice Care Enrollment Instructions

icon PDF 2020 Molina Medicare Choice Care Enrollment Form

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.

Members of Molina Medicare Choice Care (HMO) are eligible to enroll in an Optional Supplemental Dental and Vision Plan. Enrollment for the Optional Supplemental Dental and Vision Plan must be received no later than 60 days following your Molina Medicare Choice Care (HMO) effective date.  View the Molina Medicare Choice Care (HMO) Evidence of Coverage  for covered services, co-pays and eligibility information.

MAIL: Molina Healthcare, Inc.
           Attn: Membership 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 Choice Care (HMO) 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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