Medicare Forms
Medicare Advantage (Part C)

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

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.

2026 BlueMedicare Premier HMO

H1035 022 Palm Beach
H1035 025 Broward
H1035 026 Orange
H1035 033 Clay, Duval
H1035 034 Hernando, Pinellas
H1035 043 Lake, Sumter, Marion
H1035 045 Charlotte, Collier, Lee, Manatee, Sarasota
H1035 048 Brevard, St. Lucie

Annual Notice of Changes -- Palm Beach - last updated 8/26/25
Annual Notice of Changes -- Broward - last updated 8/26/25
Annual Notice of Changes -- Orange - last updated 8/26/25
Annual Notice of Changes -- Clay, Duval - last updated 8/26/25
Annual Notice of Changes -- Hernando, Pinellas - last updated 8/26/25
Annual Notice of Changes -- Lake, Marion, Sumter - last updated 8/26/25
Annual Notice of Changes -- Charlotte, Collier, Lee, Manatee, Sarasota - last updated 8/26/25
Annual Notice of Changes -- Brevard, St. Lucie - last updated 8/26/25

Evidence of Coverage -- Palm Beach - last updated 9/4/25
Evidence of Coverage -- Broward - last updated 9/4/25
Evidence of Coverage -- Orange - last updated 9/4/25
Evidence of Coverage -- Clay, Duval - last updated 9/4/25
Evidence of Coverage -- Hernando, Pinellas - last updated 9/4/25
Evidence of Coverage -- Lake, Marion, Sumter - last updated 9/4/25
Evidence of Coverage -- Charlotte, Collier, Lee, Manatee, Sarasota - last updated 9/4/25
Evidence of Coverage -- Brevard, St. Lucie - last updated 9/4/25

Summary of Benefits -- Palm Beach, Broward - last updated 8/22/25
Summary of Benefits -- Orange, Brevard, St. Lucie - last updated 8/22/25
Summary of Benefits -- Clay, Duval - last updated 8/22/25
Summary of Benefits -- Hernando, Pinellas, Charlotte, Collier, Lee, Manatee, Sarasota - last updated 8/22/25
Summary of Benefits -- Lake, Marion, Sumter - last updated 8/22/25

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

Formulary -- Statewide - last updated 9/30/25

Medicare Star Rating -- Statewide - last updated 10/16/24

Low Income Subsidy (LIS) - Extra Help Program - last updated 8/29/25

Prescription Drug Transition Policy - last updated xx/xx/xx

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