• 2025 Blue Medicare Advantage (HMO) Summary of Benefits (PDF)
• 2025 Blue Medicare Advantage (PPO) Summary of Benefits (PDF)
• 2025 Blue Medicare Freedom+ (PPO) Summary of Benefits (PDF)
• 2025 Healthy Blue + Medicare (HMO-POS D-SNP) Summary of Benefits (PDF)
• 2025 Blue Medicare Rx (PDP) Summary of Benefits (PDF)

• 2026 Summary of Benefits Blue Medicare Advantage (HMO) (PDF)
• 2026 Summary of Benefits Blue Medicare Advantage (PPO) (PDF)
• 2026 Summary of Benefits Blue Medicare Freedom+ (PPO) (PDF)
• 2026 Summary of Benefits Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)
• 2026 Summary of Benefits Blue Medicare Rx (PDP) (PDF)

2025 EOC Blue Medicare PPO Enhanced (PPO) 003-001 (PDF)

2025 EOC Blue Medicare PPO Enhanced (PPO) 003-002 (PDF)

2025 EOC Blue Medicare Freedom Plus (PPO) 004 (PDF)

2025 EOC Blue Medicare Medical Only (HMO-POS) 012 (PDF)

2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-001 (PDF)

2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-002 (PDF)

2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-004 (PDF)

2025 EOC Blue Medicare Essential Plus (HMO-POS) 023-005 (PDF)

2025 EOC Blue Medicare Enhanced (HMO-POS) 024-001 (PDF)

2025 EOC Blue Medicare Enhanced (HMO-POS) 024-002 (PDF)

2025 EOC Blue Medicare Enhanced (HMO-POS) 024-003 (PDF)

2025 EOC Blue Medicare Choice (HMO) 026 (PDF)

2025 EOC Blue Medicare Essential (HMO) 027-001 (PDF)

2025 EOC Blue Medicare Essential (HMO) 027-002 (PDF)

2025 EOC Blue Medicare Rx Standard (PDP) 002 (PDF)

2025 EOC Blue Medicare Rx Enhanced (PDP) 004 (PDF)

2025 EOC Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

2026 EOC Blue Medicare PPO Enhanced (PPO) 003-001 (PDF)

2026 EOC Blue Medicare PPO Enhanced (PPO) 003-002 (PDF)

2026 EOC Blue Medicare Freedom Plus (PPO) 004 (PDF)

2026 EOC Blue Medicare Medical Only (HMO-POS) 012 (PDF)

2026 EOC Blue Medicare Essential Plus (HMO-POS) 023-001 (PDF)

2026 EOC Blue Medicare Essential Plus (HMO-POS) 023-002 (PDF)

2026 EOC Blue Medicare Essential Plus (HMO-POS) 023-004 (PDF)

2026 EOC Blue Medicare Essential Plus (HMO-POS) 023-005 (PDF)

2026 EOC Blue Medicare Enhanced (HMO-POS) 024-001 (PDF)

2026 EOC Blue Medicare Enhanced (HMO-POS) 024-002 (PDF)

2026 EOC Blue Medicare Enhanced (HMO-POS) 024-003 (PDF)

2026 EOC Blue Medicare Choice (HMO) 026 (PDF)

2026 EOC Blue Medicare Essential (HMO) 027-001 (PDF)

2026 EOC Blue Medicare Essential (HMO) 027-002 (PDF)

2026 EOC Blue Medicare Rx Enhanced (PDP) 004 (PDF)

2026 EOC Blue Medicare Rx Standard (PDP) 002 (PDF)

2026 EOC Healthy Blue + Medicare (HMO-POS D-SNP) 001 (PDF)

• 2025 ANOC Blue Medicare Choice (HMO) 026-000 (PDF)
• 2025 ANOC Blue Medicare Enhanced (HMO-POS) 024-001 (PDF)
• 2025 ANOC Blue Medicare Enhanced (HMO-POS) 024-002 (PDF)
• 2025 ANOC Blue Medicare Enhanced (HMO-POS) 024-003 (PDF)
• 2025 ANOC Blue Medicare Essential (HMO) 027-001 (PDF)
• 2025 ANOC Blue Medicare Essential (HMO) 027-002 (PDF)
• 2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-001 (PDF)
• 2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-001 to 004 (PDF)
• 2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 (PDF)
• 2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 to 005 (PDF)
• 2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-004 (PDF)
• 2025 ANOC Blue Medicare Essential Plus (HMO-POS) 023-005 (PDF)
• 2025 ANOC Blue Medicare Medical Only (HMO-POS) 012 (PDF)
• 2025 ANOC Blue Medicare PPO Enhanced (PPO) 003-001 (PDF)
• 2025 ANOC Blue Medicare PPO Enhanced (PPO) 003-002 (PDF)
• 2025 ANOC Blue Medicare PPO Enhanced (PPO) 003-002 to 001 (PDF)
• 2025 ANOC Blue Medicare PPO Freedom Plus (PPO) 004 (PDF)
• 2025 ANOC Blue Medicare Rx Enhanced (PDP) 004 (PDF)
• 2025 ANOC Blue Medicare Rx Standard (PDP) 002 (PDF)
• 2025 ANOC Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

• 2026 ANOC Blue Medicare PPO Enhanced (PPO) 003-001 to 002 (PDF)
• 2026 ANOC Blue Medicare PPO Enhanced (PPO) 003-001 (PDF)
• 2026 ANOC Blue Medicare PPO Enhanced (PPO) 003-002 to 001 (PDF)
• 2026 ANOC Blue Medicare PPO Enhanced (PPO) 003-002 (PDF)
• 2026 ANOC Blue Medicare PPO Freedom Plus (PPO) 004 (PDF)
• 2026 ANOC Blue Medicare Medical Only (HMO-POS) 012 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-001 to 002 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-001 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 to 001 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 to 004 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-002 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-004 to 005 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-004 (PDF)
• 2026 ANOC Blue Medicare Essential Plus (HMO-POS) 023-005 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-001 to 002 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-001 to 003 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-001 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-002 to 001 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-002 to 003 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-002 (PDF)
• 2026 ANOC Blue Medicare Enhanced (HMO-POS) 024-003 (PDF)
• 2026 ANOC Blue Medicare Choice (HMO) 026-000 (PDF)
• 2026 ANOC Blue Medicare Essential (HMO) 027-001 to 002 (PDF)
• 2026 ANOC Blue Medicare Essential (HMO) 027-001 (PDF)
• 2026 ANOC Blue Medicare Essential (HMO) 027-002 to 001 (PDF)
• 2026 ANOC Blue Medicare Essential (HMO) 027-002 (PDF)
• 2026 ANOC Blue Medicare Rx Standard (PDP) 002 (PDF)
• 2026 ANOC Blue Medicare Rx Enhanced (PDP) 004 (PDF)
• 2026 ANOC Healthy Blue + Medicare (HMO-POS D-SNP) 001 (PDF)

• Liberty Dental Comprehensive Plan (PDF)
• Liberty Dental Preventive Plus Plan (PDF)
• Liberty Dental Codes (PDF)

The list of drugs covered on each plan, along with any restrictions for those drugs, can be found in the formulary.

• Log in to Blue Connect and select "Find a Medication" to view estimated costs, drug limitations or requirements, and other covered drugs.

2025 Blue Medicare Choice (HMO) (PDF)

2025 Blue Medicare Enhanced (HMO-POS) (PDF)

2025 Blue Medicare Essential (HMO) (PDF)

2025 Blue Medicare Essential Plus (HMO-POS) (PDF)

2025 Blue Medicare PPO Enhanced (PPO) (PDF)

2025 Blue Medicare Rx Enhanced (PDP) (PDF)

2025 Blue Medicare Rx Standard (PDP) (PDF)

2025 Blue Medicare HMO EGWP MAPD (PDF)

2025 Blue Medicare HMO EGWP MAPD (plans with deductible) (PDF)

2025 Blue Medicare PPO EGWP MAPD (PDF)

2025 Blue Medicare PPO EGWP Complete (PDF)

2025 Blue Medicare Rx EGWP Complete (PDF)

2025 Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

2026 Formulary Blue Medicare Choice (HMO) (PDF)

2026 Formulary Blue Medicare Enhanced (HMO-POS) (PDF)

2026 Formulary Blue Medicare Essential (HMO) (PDF)

2026 Formulary Blue Medicare Essential Plus (HMO-POS) (PDF)

2026 Formulary Blue Medicare PPO Enhanced (PPO) (PDF)

2026 Formulary Blue Medicare Rx Enhanced (PDP) (PDF)

2026 Formulary Blue Medicare Rx Standard (PDP) (PDF)

2026 Formulary Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

The Pharmacy Directory lists our network pharmacies. To locate a pharmacy in your area, log in to Blue Connect or select your plan's Pharmacy Directory PDF.

2025 Pharmacy Directory Blue Medicare HMO, PPO, and Rx (PDF)

2025 Pharmacy Directory Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

2026 Pharmacy Directory Blue Medicare (HMO), (PPO), and Rx (PDP) (PDF)

2026 Pharmacy Directory Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

2025 Star Ratings Blue Medicare (HMO) (PDF)

2025 Star Ratings Blue Medicare (PPO) (PDF)

2025 Star Ratings Blue Medicare Rx (PDP) (PDF)

2025 Star Ratings Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

2025 Star Ratings Healthy Blue + Medicare (HMO-POS D-SNP) (Spanish) (PDF)

2026 Medicare and You Handbook

• 2025 Blue Medicare Advantage HMO Enrollment Form (PDF)
• 2025 Blue Medicare Advantage PPO Enrollment Form (PDF)
• 2025 Blue Medicare Advantage Freedom+ PPO Enrollment Form (PDF)
• 2025 Blue Medicare Rx PDP Enrollment Form (PDF)
  
• 2025 Healthy Blue + Medicare (HMO-POS D-SNP) Enrollment Form (PDF)

• 2026 Individual Enrollment Form Medicare Advantage (HMO) (PDF)
• 2026 Individual Enrollment Form Medicare Advantage (PPO) (PDF)
• 2026 Individual Enrollment Form Medicare Advantage Blue Medicare Freedom+ (PPO) (PDF)
• 2026 Individual Enrollment Form Medicare Rx (PDP) (PDF)
• 2026 Individual Enrollment Form Healthy Blue + Medicare (HMO-POS D-SNP) (PDF)

• 2025 Blue Medicare HMO Change Form (PDF)
  
• 2025 Blue Medicare PPO Change Form (PDF)
• 2025 Blue Medicare Rx PDP Change Form (PDF)

• 2026 Change Form Medicare Advantage (PPO) (PDF)
• 2026 Change Form Medicare Advantage (HMO) (PDF)
• 2026 Change Form Blue Medicare Rx (PDP) (PDF)

• Medicare Medical Claim Form (PDF) Or, submit your Medical Claim online through your Blue Connect^℠ member portal.
• Medicare Prescription Drug Claim Form (PDF)
• Liberty Dental Claim Form (PDF)

• Authorization for Automatic Bank Draft Form (PDF)

• Appointment of Representative (AOR) Form (PDF)

• PHI Authorization Request Form (PDF) Or, submit your request through your Blue Connect^℠ member portal.

• Reducing Your Risk for Type 2 Diabetes - MDPP information and referral form (PDF)

• Medicare Part B vs Part D Fax Form (PDF)

• Compounded Drugs Request Fax Form (PDF)
• Coverage Determination Request Form (PDF)
• Hospice Information for Medicare Part D Plans (PDF)

Members with Blue Medicare Choice^℠, Blue Medicare Essential^℠, Blue Medicare Essential Plus^℠, Blue Medicare Enhanced^℠, and Blue Medicare PPO Enhanced^℠ can take advantage of $0 copays for select care drugs at preferred retail and mail order pharmacies, or with a low copay at standard pharmacies.

Learn more about your pharmacy network.

The Formulary Tier 6 Select Care drug list below includes a wide range of commonly prescribed generic drugs used for high blood pressure, high cholesterol, and diabetes. Talk with your doctor to determine if a Formulary Tier 6 Select Care drug is appropriate to treat your condition so  you get the best value from your pharmacy benefits.

2025 Formulary Tier 6 Select Care Drugs (PDF)