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 Preferred HMO
- H1035 052 Polk, Hillsborough
- Annual Notice of Changes -- Hillsborough, Polk - last updated 8/26/25
- Evidence of Coverage -- Hillsborough, Polk - last updated 9/4/25
- Summary of Benefits -- Hillsborough, Polk - last updated 8/22/25
- Enrollment Form -- Statewide - last updated 7/3/25
- Formulary -- Statewide - last updated 11/3/25
- 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
2025 BlueMedicare Preferred (HMO)
• H1035-052 - BlueMedicare Preferred (HMO) - Hillsborough, Polk
• 2025 Annual Notice of Changes - BlueMedicare Preferred (HMO) - Hillsborough, Polk - last updated 8/23/24
• 2025 Evidence of Coverage - BlueMedicare Preferred (HMO) - Hillsborough, Polk - last updated 5/28/25
• 2025 Summary of Benefits - BlueMedicare Preferred (HMO) - Hillsborough, Polk - last updated 8/22/24
• 2025 Enrollment Form - BlueMedicare Preferred (HMO) - last updated 4/30/25
• 2025 Medicare Star Rating - BlueMedicare Preferred (HMO) - last updated 10/16/24
• 2025 Formulary - BlueMedicare Preferred (HMO) - last updated 11/26/25
• 2025 Low Income Subsidy (LIS) - Extra Help Program - last updated 10/1/24
• 2025 Prescription Drug Transition Policy - last updated 5/28/25