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 Online2024 Online Enrollment Form2025 Online Enrollment Form
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Enroll by mailMail to:
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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 plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
*Printed copies of information posted on our website are available upon request.
