Want help? Call 855-339-5205 (TTY/TDD: 711)

Medicare Plan Documents and Forms

Find Medicare Advantage Forms

Looking for a plan document or a certain form? If you know the type of document you are looking for, you may use the filters below, or you can search by keyword.

Results

Year Links
2020 Medicare Advantage Personal Medication List do-not-filter Personal Medication List (PDF) do-not-filter 2020
2020 Medicare Advantage Star Ratings – HMO, Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO) MAPD Medicare Advantage Star Ratings do-not-filter 2020
2020 Find a Doctor MAPD Find a Doctor do-not-filter 2020
2020 Medicare Advantage Star Ratings – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO) MAPD Medicare Advantage Star Ratings do-not-filter 2020
2020 Medicare Advantage Enrollment Application do-not-filter Enrollment form Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2020
2020 Medicare Advantage Pharmacy Directory do-not-filter Pharmacy Directory Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2020
2020 Medicare Advantage Automatic Funds Transfer Authorization do-not-filter Payment Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2020
2020 Over the Counter FAQ do-not-filter Over the Counter FAQ Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2020
2020 Over the Counter Catalog do-not-filter Over the Counter Catalog Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2020
2020 Find a Pharmacy MAPD Find a Pharmacy Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2020
2020 Medicare & You MedSupp Medicare & You do-not-filter 2020
2021 Medicare & You do-not-filter Medicare & You Adams, Asotin, Benton, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2021
2021 Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturers - (HMO), Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO) do-not-filter Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturers do-not-filter 2021
2021 Over the Counter FAQ do-not-filter Over the Counter FAQ Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2021
2021 Over the Counter Catalog do-not-filter Over the Counter Catalog do-not-filter 2021
2021 Find a Doctor do-not-filter Find a Doctor do-not-filter 2021
2021 Find a Pharmacy do-not-filter Find a Pharmacy do-not-filter 2021
2021 Medicare Advantage Automatic Funds Transfer Authorization do-not-filter Payment Adams, Asotin, Benton, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2021
2021 Medicare Advantage Enrollment Application do-not-filter Enrollment form Adams, Asotin, Benton, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima 2021
2021 Medicare Advantage Star Ratings – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO) MAPD Medicare Advantage Star Ratings do-not-filter 2021
2021 Medicare Advantage Star Ratings – HMO, Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO) MAPD Medicare Advantage Star Ratings Cowlitz, Island, King, Kitsap, Lewis, Pierce, San Juan, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom 2021
2021 Pre-Enrollment Checklist MAPD Pre Enrollment Checklist do-not-filter 2021
2021 Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturers - Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO) HMO Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturers King, Pierce, Snohomish, Thurston, Whatcom 2021
2020 Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturers – HMO, Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO) do-not-filter Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturer do-not-filter 2020
2020 Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturers – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO) do-not-filter Diabetic Glucose Monitors and Supplies Preferred Brands and Manufacturer do-not-filter 2020

© 2020 Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County. Premera Blue Cross is an HMO plan with a Medicare contract. Enrollment in Premera Blue Cross depends on contract renewal. ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 888-850-8526 (TTY: 711), April 1 - September 30, Monday - Friday, 8 a.m. - 8 p.m.; October 1 - March 31, 7 days a week, 8 a.m. to 8 p.m.To join a Premera Blue Cross Medicare Advantage Plan, you must have Medicare Part A and Part B and live in the Premera Blue Cross Medicare Advantage service area (Cowlitz, Island, King, Kitsap, Pierce, Lewis, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, and Whatcom counties in Washington). Members must select a Primary Care Provider (PCP) from the Premera Blue Cross Medicare Advantage Plans provider network. For accommodation of persons with special needs at sales meetings, call 888-868-7767 (TTY/TDD: 711), April 1 - September 30, Monday - Friday, 8 a.m. - 8 p.m.; October 1 - March 31, 7 days a week, 8 a.m. to 8 p.m.