Medicare Forms
2024 BlueMedicare Classic (HMO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
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H1035-017 - Miami-Dade
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H1035-018 - Palm Beach
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H1035-019 - Broward, Martin, St. Lucie, Bay, Citrus, Clay, Duval, Escambia, Marion, Okaloosa, Santa Rosa, St. Johns, Charlotte, Collier, Lee, Manatee, Sarasota, Brevard, Lake, Sumter
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H1035-020 - Orange, Osceola, Seminole
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H1035-021 - Hernando, Hillsborough, Pasco, Polk
| 2024 Summary of Benefits | Last Updated |
|---|---|
| 2024 Summary of Benefits - Miami-Dade | 9/18/2023 |
| 2024 Summary of Benefits - Palm Beach | 9/18/2023 |
| 2024 Summary of Benefits - Bay, Escambia, Lake, Marion, Martin, Okaloosa, Santa Rosa, St. Johns and Sumter | 9/18/2023 |
| 2024 Summary of Benefits - Citrus | 9/18/2023 |
| 2024 Summary of Benefits - Orange, Osceola and Seminole | 9/18/2023 |
| 2024 Summary of Benefits - Broward | 9/26/2023 |
| 2024 Summary of Benefits - Clay and Duval | 9/18/2023 |
| 2024 Summary of Benefits - Hillsborough and Polk | 9/18/2023 |
| 2024 Summary of Benefits - Hernando and Pasco | 9/18/2023 |
| 2024 Summary of Benefits - Charlotte, Collier, Lee, Manatee and Sarasota | 9/18/2023 |
| 2024 Summary of Benefits - Brevard and St. Lucie | 9/18/2023 |
| 2024 Enrollment Form | Last Updated |
|---|---|
| 2024 Enrollment Form | 8/24/2023 |
| 2024 Medicare Star Rating | Last Updated |
|---|---|
| 2024 Medicare Star Rating | 10/12/2022 |
| 2024 Prescription Drug Transition Policy | Last Updated |
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| 2024 Prescription Drug Transition Policy | 9/20/2023 |
| 2024 Low-Income Subsidy - Extra Help Program | Last Updated |
|---|---|
| 2024 Low-Income Subsidy - Extra Help Program | 9/11/2023 |
2023 BlueMedicare Classic (HMO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
-
H1035-017 - Miami-Dade
-
H1035-018 - Palm Beach
-
H1035-019 - Broward, Martin, St. Lucie, Bay, Citrus, Clay, Duval, Escambia, Marion, Okaloosa, Santa Rosa, St. Johns, Charlotte, Collier, Lee, Manatee, Sarasota, Brevard, Lake, Sumter
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H1035-020 - Orange, Osceola, Seminole
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H1035-021 - Hernando, Hillsborough, Pasco, Polk
| Plan Document | Last Updated |
|---|---|
| 2023 Annual Notice of Changes - Miami-Dade | last updated 9/19/2022 |
| 2023 Annual Notice of Changes - Palm Beach | last updated 9/19/2022 |
| 2023 Annual Notice of Changes - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter | last updated 9/19/2022 |
| 2023 Annual Notice of Changes - Orange, Osceola, Seminole | last updated 9/19/2022 |
| 2023 Annual Notice of Changes - Hernando, Hillsborough, Pasco, Polk | last updated 9/19/2022 |
| Plan Document | Last Updated |
|---|---|
| 2023 Evidence of Coverage - Miami-Dade | last updated 9/20/2022 |
| 2023 Evidence of Coverage - Palm Beach | last updated 9/20/2022 |
| 2023 Evidence of Coverage - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter | last updated 9/20/2022 |
| 2023 Evidence of Coverage - Orange, Osceola, Seminole | last updated 9/20/2022 |
| 2023 Evidence of Coverage - Hernando, Hillsborough, Pasco, Polk | last updated 9/20/2022 |
| Plan Document | Last Updated |
|---|---|
| 2023 Summary of Benefits - Miami-Dade | last updated 8/23/2022 |
| 2023 Summary of Benefits - Palm Beach | last updated 8/23/2022 |
| 2023 Summary of Benefits - Bay, Escambia, Lake, Marion, Martin, Okaloosa, Santa Rosa, St. Johns, Sumter | last updated 8/23/2022 |
| 2023 Summary of Benefits - Citrus | last updated 8/23/2022 |
| 2023 Summary of Benefits - Orange, Osceola, Seminole | last updated 8/23/2022 |
| 2023 Summary of Benefits - Broward | last updated 8/23/2022 |
| 2023 Summary of Benefits - Clay, Duval | last updated 8/23/2022 |
| 2023 Summary of Benefits - Hillsborough, Polk | last updated 8/23/2022 |
| 2023 Summary of Benefits - Hernando, Pasco | last updated 8/23/2022 |
| 2023 Summary of Benefits - Charlotte, Collier, Lee, Manatee, Sarasota | last updated 8/23/2022 |
| 2023 Summary of Benefits - Brevard, St. Lucie | last updated 8/23/2022 |
| Plan Document | Last Updated |
|---|---|
| 2023 Enrollment Form | last updated 8/5/2022 |
| Plan Document | Last Updated |
|---|---|
| 2023 Medicare Star Rating | last updated 10/12/2022 |
| Plan Document | Last Updated |
|---|---|
| 2023 Prescription Drug Transition Policy | last updated 7/1/2022 |
| Plan Document | Last Updated |
|---|---|
| 2023 Low-Income Subsidy - Extra Help Program | last updated 9/23/2022 |