Medicare plan documents

Looking for details about our Medicare plans? Here you’ll find plan documents including provider directories, benefits overviews, enrollment forms and more.

Choose your Medicare plan name below

See documents for your Medicare plan by choosing your plan name below. If you have questions about these documents, please call customer service on the back of your member ID card.

If you'd like to enroll in a plan, visit Medicare plans for help choosing a plan.

Documents for 2025 Medicare plans

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Medicare Advantage plan below (there are five plans). These documents explain covered services and include other helpful information about your plan.

Medicare Advantage (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 7.

Medicare Advantage (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 9. 

Search for drugs

Doctors, pharmacies, and other networks

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Doctors

Pharmacies

Dental

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Medicare Advantage plan below (there are five plans). These documents explain covered services and include other helpful information about your plan.

Medicare Advantage (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 7.

Medicare Advantage (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 9.

Search for drugs

Doctors, pharmacies, and other networks

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Doctors

Pharmacies

Dental

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Medicare Advantage plan below (there are four plans). These documents explain covered services and include other helpful information about your plan.

Medicare Advantage (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 7.

Medicare Advantage (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 9.

Search for drugs

Doctors, pharmacies, and other networks

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Doctors

Pharmacies

Dental

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Platinum Blue plan below (there are three medical-only plans and three plans with medical and drug benefits). These documents explain covered services and include other helpful information about your plan.

Platinum Blue (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Platinum Blue - document. For information about appeals and grievances, see Chapter 7.

Platinum Blue with Rx (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Platinum Blue - document. For information about appeals and grievances, see Chapter 9.

Search for drugs

Doctors, pharmacies, and other networks

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Doctors

Pharmacies

Dental

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview and coverage information

If you are enrolled in this plan, here are summaries of your coverage:

Doctors

To get the most coverage from your plan, choose doctors, hospitals and clinics in the plan network.

Fitness program

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview, pharmacies and coverage

If you are enrolled in this stand-alone Medicare prescription drug plan, visit:

Doctors, pharmacies, and other networks

To get the most coverage from your plan, choose doctors, clinics, hospitals and pharmacies in the plan network.

Group Medicare Advantage PPO

Doctors

Pharmacies

Drugs

Dental

Group Platinum Blue (Cost)

Doctors

Pharmacies

  • Part B Pharmacy Directory – locations to fill certain outpatient drugs that are covered under your Medicare Part B plan benefit.

Other information and forms

Documents for 2024 Medicare plans

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Medicare Advantage plan below (there are five plans). These documents explain covered services and include other helpful information about your plan.

Medicare Advantage (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 7.

Medicare Advantage (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 9. 

Doctors, pharmacies, and other networks

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Medicare Advantage plan below (there are five plans). These documents explain covered services and include other helpful information about your plan.

Medicare Advantage (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 7.

Medicare Advantage (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 9.

Doctors and pharmacies

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Medicare Advantage plan below (there are four plans). These documents explain covered services and include other helpful information about your plan.

Medicare Advantage (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 7.

Medicare Advantage (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Medicare Advantage document. For information about appeals and grievances, see Chapter 9.

Doctors and pharmacies

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview

If you are enrolled in this plan, here are summaries of your coverage:

Plan coverage

Choose your Platinum Blue plan below (there are three medical-only plans and three plans with medical and drug benefits). These documents explain covered services and include other helpful information about your plan.

Platinum Blue (medical only)

For information about your rights and responsibilities, please see Chapter 6 of your Evidence of Coverage Platinum Blue - document. For information about appeals and grievances, see Chapter 7.

Platinum Blue with Rx (medical and Rx)

For information about other rights and responsibilities, please see Chapter 8 of your Evidence of Coverage Platinum Blue - document. For information about appeals and grievances, see Chapter 9.

Doctors and pharmacies

To get the most coverage from your plan, choose dentists, doctors, clinics, hospitals and pharmacies in the plan network.

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview and coverage information

If you are enrolled in this plan, here are summaries of your coverage:

Doctors

To get the most coverage from your plan, choose doctors, hospitals and clinics in the plan network.

Fitness program

Other information and forms

Enrollment

These forms are used to enroll in this plan. You can download them here, or order enrollment materials to be mailed to you.

Plan overview, pharmacies and coverage

If you are enrolled in this stand-alone Medicare prescription drug plan, visit:

Doctors and pharmacies

To get the most coverage from your plan, choose doctors, clinics, hospitals and pharmacies in the plan network.

Group Medicare Advantage PPO

Group Platinum Blue (Cost)

Other information and forms

Medicare Workshops

Learn about Medicare and your plan choices at a free, no obligation workshop.

Find a Workshop

Blue Cross Medicare Advisors

A Blue Cross Advisor will meet with you in person or virtually to answer your questions and enroll you in a Medicare plan.

Meet with an Advisor