Molina Medicare
Enrollment Form
and Instructions
Molina Medicare Options is a plan offered by Molina Healthcare, a health plan with a Medicare contract. All eligible Medicare beneficiaries entitled to Medicare Part A and enrolled in Part B may apply. Members must reside in the Molina service area, must continue to pay your Medicare Part B premium, and must receive all routine care from Molina plan providers. If you obtain routine care from out of plan providers, neither Medicare nor Molina will be responsible for the cost.
Molina’s Medicare Prescription Drug Benefit is only available to members of the plan and you must receive your drug benefit through Molina, not another organization. Molina’s contract with CMS is renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. Members may enroll in the plan only during specific times of the year.
Medicare beneficiaries entitled to Medicare Part A and enrolled in Part B who qualify for Medi-Cal are eligible for Molina Medicare Options. You must live in the Molina Medicare service area. Individuals are not eligible to elect
a Molina Medicare plan if they have End Stage Renal Disease (ESRD),
except in specific situations.
You must continue to pay your Medicare Part B premium if not paid for by another third party. Molina Medicare enrollments online. Please
click here
to download a printable copy of the enrollment form and follow the instructions on
it if you are interested in applying. We encourage you to
read the Summary of Benefits on this website before
completing an enrollment form.
If you have any questions, please e-mail us or call Member Services at 1-866-440-0012 (TTY/TDD 1-800-346-4128). (Hours of Operation: Monday through Sunday 8:00 a.m. to 8:00 p.m.)
*Paper copies of information posted
on our web site are available upon request.
Molina Medicare is an organization with a
Medicare contract. This contract is renewed annually,
and coverage beyond the end of the contract year is not
guaranteed.
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