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EXHIBIT 1: MODEL INDIVIDUAL ENROLLMENT REQUEST FOR MTO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) MEDICARE PRESCRIPTION DRUG PLAN (PART D)Who can use this form? Reminders: If you want to join a
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To fill out Molina Medicare Complete Care, follow these steps:
02
Gather all necessary personal information, such as your full name, address, date of birth, and Social Security number.
03
Have your Medicare card ready, as you will need the information on it.
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Understand the different parts of Molina Medicare Complete Care, including the medical and prescription drug coverage options.
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Visit the Molina Medicare website or call their customer service line to obtain the enrollment form.
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Fill out the enrollment form completely and accurately, providing all required information.
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Review your completed form for any errors or missing information before submitting it.
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Submit the form as instructed by Molina Medicare, either by mailing it or completing an online submission.
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Wait for confirmation from Molina Medicare regarding your enrollment. They will provide you with further instructions and information on how to proceed.

Who needs molina medicare complete care?

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Molina Medicare Complete Care is designed for individuals who meet the following criteria:
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- Individuals who are eligible for Medicare benefits
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- Individuals who require comprehensive medical and prescription drug coverage
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- Individuals who prefer to have their healthcare needs managed by a designated Medicare Advantage plan
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- Individuals who want additional benefits not offered by Original Medicare, such as dental, vision, or hearing coverage
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- Individuals who are looking for a single plan that combines all their Medicare coverage needs
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Molina Medicare Complete Care is a Medicare Advantage plan offered by Molina Healthcare.
Individuals who are enrolled in Molina Medicare Complete Care are required to file the necessary documents.
To fill out Molina Medicare Complete Care, individuals can contact Molina Healthcare for assistance or visit their online portal.
The purpose of Molina Medicare Complete Care is to provide comprehensive healthcare coverage to individuals enrolled in the plan.
Information such as medical history, prescriptions, and healthcare provider visits must be reported on Molina Medicare Complete Care.
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