Medicare Forms
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BlueMedicare Select (PPO)
2023 Service Area
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H5434-002 - Broward, Palm Beach, St. Lucie, Charlotte, Collier, Highlands, Hillsborough, Lee, Manatee, Pinellas, Orange, Osceola, Bay, Duval, Escambia, Marion, Santa Rosa
BlueMedicare Select (PPO)
2023 Plan Documents
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2023 Annual Notice of Changes
2023 Evidence of Coverage
2023 Summary of Benefits
2023 Comprehensive Formulary
- 2023 Comprehensive Formulary, last updated 01/15/2023
2023 Enrollment Form
- 2023 Enrollment Form, last updated 8/11/2022
2023 Medicare Star Rating
- 2023 Medicare Star Rating, last updated 10/12/2022
2023 Prescription Drug Transition Policy
- 2023 Prescription Drug Transition Policy, last updated 7/1/2022
2023 Low-Income Subsidy - Extra Help Program
- 2023 Low-Income Subsidy - Extra Help Program, last updated 9/23/2022
Call Florida Blue for help with your Medicare plan.
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1-800-926-6565 (TTY 1-800-955-8770)
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From Apr. 1 - Sept. 30, we are open Monday to Friday, 8 a.m. - 8 p.m. local time.