Area I
- Franklin
- Johnson
- Logan
- Scott
Health Advantage HMO enrollment form - Spanish
Health Advantage Blue Classic (HMO) - Formulary [pdf]
Health Advantage Blue Classic (HMO) - Pharmacy Directory [pdf]
Health Advantage Blue Classic (HMO) - Find Pharmacies
Annual Notice of Change - English
Annual Notice of Change - Spanish
Appeals & grievances
ACH form (H9699)
Health Advantage SSA form
Low income subsidy table (H9699)
2021 Medicare Star Ratings (H9699)
2021 Medicare Star Ratings (H9699) - Spanish
2021 Evidence of Coverage
Summary of Benefits - English
Summary of Benefits - Spanish
Health Advantage Blue Classic (HMO) - Formulary [pdf]
Health Advantage Blue Classic (HMO) - Pharmacy Directory [pdf]
Health Advantage Blue Classic (HMO) - Find Pharmacies
Annual Notice of Change - English
Annual Notice of Change - Spanish
Appeals & grievances
ACH form (H9699)
Health Advantage SSA form
Low income subsidy table (H9699)
2021 Medicare Star Ratings (H9699)
2021 Medicare Star Ratings (H9699) - Spanish
2021 Evidence of Coverage
Summary of Benefits - English
Summary of Benefits - Spanish
BlueMedicare Premier (HMO) - Formulary 002 [pdf]
BlueMedicare HMO - Pharmacy Directory [pdf]
BlueMedicare Premier (HMO) - Find Pharmacies
Appeals & grievances
ACH form (H6158)
BlueMedicare SSA form
Low income subsidy table (H6158)
2021 Medicare Star Ratings (H6158)
2021 Medicare Star Ratings (H6158) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare HMO - Pharmacy Directory [pdf]
BlueMedicare Premier (HMO) - Find Pharmacies
Appeals & grievances
ACH form (H6158)
BlueMedicare SSA form
Low income subsidy table (H6158)
2021 Medicare Star Ratings (H6158)
2021 Medicare Star Ratings (H6158) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare Preferred (PFFS) - Formulary [pdf]
BlueMedicare Preferred (PFFS) - Pharmacy Directory [pdf]
BlueMedicare Preferred (PFFS) - Find Pharmacies
Annual Notice of Change
Appeals & grievances
ACH form (H4213)
BlueMedicare SSA form
Low income subsidy table (H4213)
2021 Medicare Star Ratings (H4213)
2021 Medicare Star Ratings (H4213) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare Preferred (PFFS) - Pharmacy Directory [pdf]
BlueMedicare Preferred (PFFS) - Find Pharmacies
Annual Notice of Change
Appeals & grievances
ACH form (H4213)
BlueMedicare SSA form
Low income subsidy table (H4213)
2021 Medicare Star Ratings (H4213)
2021 Medicare Star Ratings (H4213) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare Value Choice (PPO) - Formulary 004-006 [pdf]
BlueMedicare PPO - Pharmacy Directory [pdf]
BlueMedicare Value Choice (PPO) - Find Pharmacies
Appeals & grievances
ACH form (H3554)
BlueMedicare SSA form
Low income subsidy table (H3554)
2021 Medicare Star Ratings (H3554)
2021 Medicare Star Ratings (H3554) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare PPO - Pharmacy Directory [pdf]
BlueMedicare Value Choice (PPO) - Find Pharmacies
Appeals & grievances
ACH form (H3554)
BlueMedicare SSA form
Low income subsidy table (H3554)
2021 Medicare Star Ratings (H3554)
2021 Medicare Star Ratings (H3554) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare Premier Choice (PPO) - Formulary 008-010 [pdf]
BlueMedicare PPO - Pharmacy Directory [pdf]
BlueMedicare Premier Choice (PPO) - Find Pharmacies
Appeals & grievances
ACH form (H3554)
BlueMedicare SSA form
Low income subsidy table (H3554)
2021 Medicare Star Ratings (H3554)
2021 Medicare Star Ratings (H3554) - Spanish
2021 Evidence of Coverage
Summary of Benefits
BlueMedicare PPO - Pharmacy Directory [pdf]
BlueMedicare Premier Choice (PPO) - Find Pharmacies
Appeals & grievances
ACH form (H3554)
BlueMedicare SSA form
Low income subsidy table (H3554)
2021 Medicare Star Ratings (H3554)
2021 Medicare Star Ratings (H3554) - Spanish
2021 Evidence of Coverage
Summary of Benefits
Y0083_MA Website
Last updated 10/01/2020