Medicare Forms

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BlueMedicare Classic (HMO)
2023 Service Area
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H1035-017 - Miami-Dade
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H1035-018 - Palm Beach
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H1035-019 - Broward, Martin, St. Lucie, Bay, Citrus, Clay, Duval, Escambia, Marion, Okaloosa, Santa Rosa, St. Johns, Charlotte, Collier, Lee, Manatee, Sarasota, Brevard, Lake, Sumter
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H1035-020 - Orange, Osceola, Seminole
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H1035-021 - Hernando, Hillsborough, Pasco, Polk
Important 2023 benefit information, last updated 2/14/2023
BlueMedicare Classic (HMO)
2023 Plan Documents
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2023 Annual Notice of Changes
Plan Document | Last Updated |
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2023 Annual Notice of Changes - Miami-Dade | last updated 9/19/2022 |
2023 Annual Notice of Changes - Palm Beach | last updated 9/19/2022 |
2023 Annual Notice of Changes - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter | last updated 9/19/2022 |
2023 Annual Notice of Changes - Orange, Osceola, Seminole | last updated 9/19/2022 |
2023 Annual Notice of Changes - Hernando, Hills, Pasco, Polk | last updated 9/19/2022 |
2023 Evidence of Coverage
Plan Document | Last Updated |
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2023 Evidence of Coverage - Miami-Dade | last updated 9/20/2022 |
2023 Evidence of Coverage - Palm Beach | last updated 9/20/2022 |
2023 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 | last updated 9/20/2022 |
2023 Evidence of Coverage - Orange, Osceola, Seminole | last updated 9/20/2022 |
2023 Evidence of Coverage - Hernando, Hillsborough, Pasco, Polk | last updated 9/20/2022 |
2023 Summary of Benefits
Plan Document | Last Updated |
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2023 Summary of Benefits - Miami-Dade | last updated 8/23/2022 |
2023 Summary of Benefits - Palm Beach | last updated 8/23/2022 |
2023 Summary of Benefits - Bay, Escambia, Lake, Marion, Martin, Okaloosa, Santa Rosa, St. Johns, Sumter | last updated 8/23/2022 |
2023 Summary of Benefits - Citrus | last updated 8/23/2022 |
2023 Summary of Benefits - Orange, Osceola, Seminole | last updated 8/23/2022 |
2023 Summary of Benefits - Broward | last updated 8/23/2022 |
2023 Summary of Benefits - Clay, Duval | last updated 8/23/2022 |
2023 Summary of Benefits - Hillsborough, Polk | last updated 8/23/2022 |
2023 Summary of Benefits - Hernando, Pasco | last updated 8/23/2022 |
2023 Summary of Benefits - Charlotte, Collier, Lee, Manatee, Sarasota | last updated 8/23/2022 |
2023 Summary of Benefits - Brevard, St. Lucie | last updated 8/23/2022 |
2023 Comprehensive Formulary
2023 Enrollment Form
Plan Document | Last Updated |
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2023 Enrollment Form | last updated 8/5/2022 |
2023 Medicare Star Rating
Plan Document | Last Updated |
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2023 Medicare Star Rating | last updated 10/12/2022 |
2023 Prescription Drug Transition Policy
Plan Document | Last Updated |
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2023 Prescription Drug Transition Policy | last updated 7/1/2022 |
2023 Low-Income Subsidy - Extra Help Program
Plan Document | Last Updated |
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2023 Low-Income Subsidy - Extra Help Program | last updated 9/23/2022 |