Medicare Forms
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 Rx
- S5904 001 Florida Statewide
- Annual Notice of Changes -- Florida - last updated 8/26/25
- Evidence of Coverage -- Florida - last updated 9/4/25
- Summary of Benefits -- Statewide - last updated 8/22/25
- Enrollment Form -- Statewide - last updated 8/13/25
- Comprehensive Formulary -- Statewide - last updated 3/16/26
- Medicare Star Rating -- Statewide - last updated 10/13/25
- Low Income Subsidy (LIS) - Extra Help Program - last updated 8/29/25
- Prescription Drug Transition Policy - last updated 5/28/25