As of January 1, 2027, Central Health Medicare Plan will no longer offer Medicare coverage. All Medicare coverage will end December 31, 2026. You can go to Welcome to Medicare or call 1-800-MEDICARE (1-800-633-4227) to pick another Medicare plan in your area.For more information, please contact the Central Health Medicare Plan at [1-855-665-4627].

Appointment of Representative (AOR)

You can appoint someone (such as a relative, friend, advocate, attorney, or physician) to act as your representative to file a grievance, request an organization or coverage determination, or deal with any of the levels of the appeals process by filling out CMS Form-1696 below.

If you would like to appoint a representative, you and your appointed representative must complete this form and mail it to Molina Medicare at:

Molina Medicare
7050 Union Park Center, Suite 600
Midvale, UT 84047



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