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Medicare Forms
Medicare Advantage (Part C)

View and download important forms and documents about your BlueMedicare plan from Florida Blue.

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Call Member Services at 1-800-926-6565 (TTY 1-800-955-8770)

Hours: 8 a.m. to 8 p.m. local time, seven days a week, from October 1 through March 31, except for Thanksgiving and Christmas. From April 1 through September 30, our hours are 8 a.m. to 8 p.m. local time, Monday through Friday, except for major holidays.

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2025 BlueMedicare Premier (HMO)

• H1035-022 - BlueMedicare Premier (HMO) - Palm Beach
• H1035-025 - BlueMedicare Premier (HMO) - Broward
• H1035-026 - BlueMedicare Premier (HMO) - Orange, Osceola
• H1035-033 - BlueMedicare Premier (HMO) - Clay, Duval
• H1035-034 - BlueMedicare Premier (HMO) - Hernando, Pinellas
• H1035-043 - BlueMedicare Premier (HMO) - Lake, Sumter, Marion
• H1035-045 - BlueMedicare Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota
• H1035-048 - BlueMedicare Premier (HMO) - Brevard, St. Lucie

•    2025 Annual Notice of Changes - Premier (HMO) - Palm Beach - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Hillsborough, Polk - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Broward - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Orange, Osceola - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Clay, Duval - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Hernando, Pinellas - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Lake, Marion, Sumter - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota - last updated 8/23/24
•    2025 Annual Notice of Changes - Premier (HMO) - Brevard, St. Lucie - last updated 8/23/24

•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Palm Beach - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Broward - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Orange, Osceola - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Clay, Duval - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Hernando, Pinellas - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Lake, Marion, Sumter - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota - last updated 9/3/24
•    2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Brevard, St. Lucie - last updated 9/3/24

•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Palm Beach - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Broward - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Clay, Duval - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Brevard, St. Lucie - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Orange, Osceola - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Hernando, Pinellas - last updated 8/22/24
•    2025 Summary of Benefits - BlueMedicare Premier (HMO) - Lake, Marion, Sumter - last updated 8/22/24

• 2025 Enrollment Form - BlueMedicare Premier (HMO) - last updated 7/12/24

• 2025 Medicare Star Rating - BlueMedicare Premier (HMO) - last updated 10/16/24

• 2025 Formulary - BlueMedicare Premier (HMO) - last updated 5/28/2025

• 2025 Low Income Subsidy (LIS) - Extra Help Program - last updated 10/1/24

• 2025 Prescription Drug Transition Policy - last updated 5/28/25

FBM FORM NF

Last Updated: 10.01.2024
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