How To Enroll (Medicare-Medicaid Plan)

How to Enroll

How to Enroll in the Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan)

If you qualify, completing the Health Plan Choice Form is easy! Follow the three simple steps to begin your enrollment into the Anthem Blue Cross Cal MediConnect Plan. You can also get free help with this form by calling Health Care Options at 1-844-580-7272 (TTY: 1-800-430-7077) Monday through Friday from 8 a.m. to 6 p.m.

The Los Angeles County Health Plan Choice Form is the document you will need to submit. The examples below will help show you how to fill out the form.

Add your personal information:

Select Anthem from Option A:

Sign and date the form:

Mail the completed form to:

California Department of Health Care Services
Health Care Options
P.O. Box 989009
West Sacramento, CA 95798-9850

If you have questions about mailing your form, or would like a free addressed and stamped envelope, please contact Member Services toll free at 1‑888‑350‑3447 (TTY: 711), Monday through Friday from 8 a.m. to 8 p.m. for more information.

Health Care Options Website: https://www.healthcareoptions.dhcs.ca.gov/

Health Care Options Phone Number: 1-844-580-7272 (TTY: 1-800-430-7077) Monday through Friday from 8 a.m. to 6 p.m.

You can also call Member Services at 1-888-350-3447 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. for more information. This call is free.

H6229_22_3001707_U CMS Accepted 12/29/2021. Page last updated on 01/01/2022.

Member Services
1-888-350-3447 (TTY: 711)
Monday through Friday from 8 a.m. to 8 p.m. This call is free.

Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan)
12900 Park Plaza Drive, Suite 150 Mailstop 6150, Cerritos, CA 90703

Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Enrollment in Anthem Blue Cross Cal MediConnect Plan depends on contract renewal.

Anthem Blue Cross is the trade name for Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Anthem Blue Cross Cal MediConnect Plan Member Handbook.

© 2022 Anthem Insurance Companies, Inc.