BlueMedicare Classic (HMO)

2021 Summary of Benefits

Summary of Benefits - Hernando, Hillsborough, Pasco, Polk (PDF)

Summary of Benefits - Miami-Dade (PDF)

Summary of Benefits - Orange, Osceola, Seminole (PDF)

Summary of Benefits - Palm Beach (PDF)

Summary of Benefits - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter (PDF)


2021 Evidence of Coverage

Evidence of Coverage - Miami-Dade (PDF)

Evidence of Coverage - Palm Beach (PDF)

Evidence of Coverage - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter (PDF)

Evidence of Coverage - Orange, Osceola, Seminole (PDF)

Evidence of Coverage - Hernando, Hillsborough, Pasco, Polk (PDF)


2021 Annual Notice of Change

Annual Notice of Change - Miami-Dade (PDF)

Annual Notice of Change - Palm Beach (PDF)

Annual Notice of Change - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter (PDF)

Annual Notice of Change - Orange, Osceola, Seminole (PDF)

Annual Notice of Change - Hernando, Hillsborough, Pasco, Polk (PDF)


2021 Comprehensive Formulary

Comprehensive Formulary - Miami-Dade (PDF)

Comprehensive Formulary - Palm Beach (PDF)

Comprehensive Formulary - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter / Orange, Osceola, Seminole / Hernando, Hillsborough, Pasco, Polk (PDF)


2021 Other Information and Documents

Enrollment Form (PDF)

Service Area Map (PDF)

Medicare Star Rating (PDF)

Low-Income Subsidy - Medicare Extra Help Program (PDF)

Prescription Drug Transition Policy (PDF)