Medicare Forms
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BlueMedicare Value (PPO)
2023 Service Area
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H5434-023 - Pinellas
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H5434-024 - Highlands, Manatee, Sarasota
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H5434-025 - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton
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H5434-026 - Broward, Indian River, Martin, Palm Beach, St. Lucie
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H5434-030 - Charlotte, Collier, Lee
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H5434-031 - Clay, Duval, Nassau, St. Johns, Flagler, Volusia
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H5434-032 - Miami-Dade
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H5434-033 - Brevard, Orange, Osceola, Seminole
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H5434-034 - Polk, Hillsborough
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H5434-035 - Hernando, Pasco
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H5434-036 - Lake, Sumter, Marion
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H5434-039 - Alachua, Citrus
BlueMedicare Value (PPO)
2023 Plan Documents
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2023 Annual Notice of Changes
- 2023 Annual Notice of Changes - Pinellas, last updated 9/19/2022
- 2023 Annual Notice of Changes - Highlands, Manatee, Sarasota, last updated 9/19/2022
- 2023 Annual Notice of Changes - Bay, Escambia, Leon, Okaloosa, Santa Rosa and Walton last updated 9/19/2022
- 2023 Annual Notice of Changes - Broward, Indian River, Martin, Palm Beach, St. Lucie, last updated 9/19/2022
- 2023 Annual Notice of Changes - Charlotte, Collier, Lee, last updated 9/19/2022
- 2023 Annual Notice of Changes - Clay, Duval, Flagler, Nassau, St. Johns, Volusia, last updated 9/19/2022
- 2023 Annual Notice of Changes - Miami-Dade, last updated 9/19/2022
- 2023 Annual Notice of Changes - Brevard, Orange, Osceola, Seminole, last updated 9/19/2022
- 2023 Annual Notice of Changes - Hillsborough, Polk, last updated 9/19/2022
- 2023 Annual Notice of Changes - Hernando, Pasco, last updated 9/19/2022
- 2023 Annual Notice of Changes - Lake, Marion, Sumter, last updated 9/19/2022
- 2023 Annual Notice of Changes - Alachua, Citrus, last updated 9/19/2022
2023 Evidence of Coverage
- 2023 Evidence of Coverage - Pinellas, last updated 9/20/2022
- 2023 Evidence of Coverage - Highlands, Manatee, Sarasota, last updated 9/20/2022
- 2023 Evidence of Coverage - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, last updated 9/20/2022
- 2023 Evidence of Coverage - Broward, Indian River, Martin, Palm Beach, St. Lucie, last updated 9/20/2022
- 2023 Evidence of Coverage - Charlotte, Collier, Lee, last updated 9/20/2022
- 2023 Evidence of Coverage - Clay, Duval, Flagler, Nassau, St Johns, Volusia, last updated 9/20/2022
- 2023 Evidence of Coverage - Miami-Dade, last updated 9/20/2022
- 2023 Evidence of Coverage - Brevard, Orange, Osceola, Seminole last updated 9/20/2022
- 2023 Evidence of Coverage - Hillsborough, Polk, last updated 9/20/2022
- 2023 Evidence of Coverage - Hernando, Pasco, last updated 9/20/2022
- 2023 Evidence of Coverage - Lake, Marion, Sumter, last updated 9/20/2022
- 2023 Evidence of Coverage - Alachua, Citrus, last updated 9/20/2022
2023 Summary of Benefits
- 2023 Summary of Benefits - Pinellas, last updated 9/12/2022
- 2023 Summary of Benefits - Hernando, Pasco, last updated 9/12/2022
- 2023 Summary of Benefits - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, last updated 9/12/2022
- 2023 Summary of Benefits - Clay, Duval, Flagler, Nassau, St. Johns, Volusia, last updated 9/12/2022
- 2023 Summary of Benefits - Broward, Indian River, Martin, Palm Beach, St. Lucie, Miami-Dade, last updated 9/12/2022
- 2023 Summary of Benefits - Highlands, Manatee, Sarasota, Charlotte, Collier, Lee, last updated 9/12/2022
- 2023 Summary of Benefits - Brevard, Orange, Osceola, Seminole, last updated 9/12/2022
- 2023 Summary of Benefits - Hillsborough, Polk, last updated 9/12/2022
- 2023 Summary of Benefits - Lake, Marion, Sumter, last updated 9/12/2022
- 2023 Summary of Benefits - Alachua, Citrus, last updated 9/12/2022
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
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