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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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2026 BlueMedicare Patriot PPO

H5434 038 Lake, Sumter, Marion
H5434 040 Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton
H5434 041 Alachua, Clay, Duval, Nassau, St. Johns
H5434 042 Charlotte, Collier, Hernando, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Sarasota, Citrus, Polk
H5434 044 Brevard, Broward, Flagler, Miami-Dade, Orange, Osceola, Seminole, Volusia, Indian River, Martin, Palm Beach, St. Lucie
H5434 046 Monroe, Okeechobee, DeSoto, Glades, Hardee, Hendry, Baker, Bradford, Columbia, Dixie, Gilchrist, Gulf, Hamilton, Holmes, Jackson, Lafayette, Levy, Madison, Putnam, Suwannee, Taylor, Union, Washington

Annual Notice of Changes -- Lake, Marion, Sumter - last updated 8/26/25
Annual Notice of Changes -- Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton - last updated 8/26/25
Annual Notice of Changes -- Alachua, Clay, Duval, Nassau, St. Johns - last updated 8/26/25
Annual Notice of Changes -- Charlotte, Citrus, Collier, Hernando, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, Sarasota - last updated 8/26/25
Annual Notice of Changes -- Brevard, Broward, Flagler, Indian River, Martin, Miami-Dade, Orange, Osceola, Palm Beach, Seminole, St. Lucie, Volusia - last updated 8/26/25
Annual Notice of Changes -- Baker, Bradford, Columbia, DeSoto, Dixie, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Holmes, Jackson, Lafayette, Levy, Madison, Monroe, Okeechobee, Putnam, Suwannee, Taylor, Union, Washington - last updated 8/26/25

Evidence of Coverage -- Lake, Marion, Sumter - last updated 9/4/25
Evidence of Coverage -- Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton - last updated 9/4/25
Evidence of Coverage -- Alachua, Clay, Duval, Nassau, St. Johns - last updated 9/4/25
Evidence of Coverage -- Charlotte, Citrus, Collier, Hernando, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, Sarasota - last updated 9/4/25
Evidence of Coverage -- Brevard, Broward, Flagler, Indian River, Martin, Miami-Dade, Orange, Osceola, Palm Beach, Seminole, St. Lucie, Volusia - last updated 9/4/25
Evidence of Coverage -- Baker, Bradford, Columbia, DeSoto, Dixie, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Holmes, Jackson, Lafayette, Levy, Madison, Monroe, Okeechobee, Putnam, Suwannee, Taylor, Union, Washington - last updated 9/4/25

Summary of Benefits -- Lake, Marion, Sumter - last updated 9/4/25
Summary of Benefits -- Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton - last updated 9/4/25
Summary of Benefits -- Alachua, Clay, Duval, Nassau, and St. Johns - last updated 9/4/25
Summary of Benefits -- Charlotte, Citrus, Collier, Hernando, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, Sarasota - last updated 9/4/25
Summary of Benefits -- Brevard, Broward, Flagler, Indian River, Martin, Miami-Dade, Orange, Osceola, Palm Beach, Seminole, St. Lucie, Volusia - last updated 9/4/25
Summary of Benefits -- Baker, Bradford, Columbia, DeSoto, Dixie, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Holmes, Jackson, Lafayette, Levy, Madison, Monroe, Okeechobee, Putnam, Suwannee, Taylor, Union, Washington - last updated 9/4/25

Enrollment Form -- Statewide - last updated 7/3/25

Medicare Star Rating -- Statewide - last updated 10/13/25

FBM FORM NF

Last Updated: 10.01.2025
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