AlohaCare - Enrollment Disclaimer

By completing this process you will be sending an enrollment application to AlohaCare. The enrollment process is not complete until your application has been submitted, reviewed and approved. If approved, you will be enrolled into the plan.

* Required

I am a Medicare beneficiary and am enrolling for myself.
I am a legal representative of a Medicare beneficiary and authorized to enroll this beneficiary into a Medicare Advantage Prescription Drug plan. You will be asked to submit the documentation (Power of Attorney) when we receive the application.
I am a Certified AlohaCare Agent/Broker
Broker ID:

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No, I am not ready to enroll into AlohaCare Advantage Plus (HMO SNP) and would like to review more plan information. Take me back to so I can learn more about the plan.

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