Medicare Forms
Medicare Advantage (Part C)

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

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2025 BlueMedicare Select (PPO)

• H5434-002 - BlueMedicare Select (PPO) - Broward, Palm Beach, St. Lucie, Miami-Dade, Charlotte, Collier, Highlands, Hillsborough, Lee, Manatee, Pinellas, Orange, Osceola, Seminole, Bay, Duval, Escambia, Marion, Santa Rosa
• H5434-045 - BlueMedicare Select (PPO) - Monroe, Okeechobee, Collier, DeSoto, Glades, Hardee, Hendry, Pasco, Alachua, Baker, Bradford, Columbia, Dixie, Gilchrist, Gulf, Hamilton, Holmes, Jackson, Lafayette, Levy, Madison, Putnam, Suwannee, Taylor, Union, Washington

• 2025 Annual Notice of Changes - BlueMedicare Select (PPO) - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie - last updated 9/12/24

• 2025 Evidence of Coverage - BlueMedicare Select (PPO) - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Miami-Dade, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, Seminole, St. Lucie - last updated 5/28/25
• 2025 Evidence of Coverage - BlueMedicare Select (PPO) - Alachua, Baker, Bradford, Collier, Columbia, DeSoto, Dixie, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Holmes, Jackson, Lafayette, Levy, Madison, Monroe, Okeechobee, Pasco, Putnam, Suwannee, Taylor, Union, Washington - last updated 5/28/25

•    2025 Summary of Benefits - BlueMedicare Select (PPO) - Bay, Broward, Charlotte, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Miami-Dade, Palm Beach, Pinellas, Santa Rosa, St. Lucie - last updated 8/30/24
•    2025 Summary of Benefits - BlueMedicare Select (PPO) - Orange, Osceola, Seminole - last updated 8/30/24
•    2025 Summary of Benefits - BlueMedicare Select (PPO) - Baker, Bradford, Columbia, DeSoto, Dixie, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Holmes, Jackson, Lafayette, Levy, Madison, Monroe, Okeechobee, Pasco, Putnam, Suwannee, Taylor, Union, Washington - last updated 8/30/24
•    2025 Summary of Benefits - BlueMedicare Select (PPO) - Alachua - last updated 8/30/24
•    2025 Summary of Benefits - BlueMedicare Select (PPO) - Collier - last updated 8/30/24