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MEDICARE

Medicare Advantage Prescription Drug Plan documents

All of your Blue Shield of California Medicare Advantage plan documents, including the enrollment form, enrollment checklist, multi-language notice, and Medicare Star Ratings are listed on this page.

You can use plan documents to help you understand your plan.

Evidence of Coverage (EOC) describes in detail the healthcare benefits covered by your plan.

Summary of Benefits (SOB) is a simplified document that summarizes your health benefits and coverage.

Annual Notice of Changes (ANOC) is a summary of any changes in the costs and coverage of your plan, effective each January 1.

Please note: If you are a member transitioning to a new plan on January 1, 2023, please look for your ANOC in your new plan’s section below.

You can also log into your online account and go to the Benefits section on your member dashboard.

If you want help understanding your documents, please call:

  • Blue Shield of California Medicare Advantage Prescription Drug Plans Customer Care at: (800) 776-4466 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.
  • Blue Shield Balance (HMO) Customer Care at: (888) 802-4423 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.
  • Blue Shield TotalDual Plan (HMO D-SNP) and Blue Shield Inspire (HMO D-SNP) Customer care at: (800) 452-4413 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.
  • For help in your language, please review the Multilanguage Notice and the Nondiscrimination Notice located for download on this page.

Blue Shield 65 Plus (HMO)

Blue Shield Inspire (HMO), Blue Shield Enhanced (HMO), and Blue Shield Select (PPO)

Blue Shield Balance (HMO) and Blue Shield AdvantageOptimum Plan (HMO)

Blue Shield TotalDual Plan (HMO D-SNP) and Blue Shield Inspire (HMO D-SNP)

Multi-language and nondiscrimination notices, Blue Shield MA-PD star ratings

  • Multi-language and Nondiscrimination Notices

    Blue Shield Medicare Advantage Prescription Drug Plans Multi-language notice English (PDF, 494 KB)

    Blue Shield Medicare Advantage Prescription Drug Plans nondiscrimination notice English (PDF, 584 KB) / Español (PDF, 44 KB)

    Blue Shield TotalDual Plan (HMO D-SNP) and Blue Shield Inspire (HMO D-SNP) Multi-language notice English (PDF, 648 KB)

    Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties Language assistance notice English (PDF, 1.2 MB)

  • Blue Shield MA-PD Star ratings*

    Blue Shield Blue Shield 65 Plus (HMO), Blue Shield Inspire (HMO), Blue Shield Enhanced (HMO), and Blue Shield Balance (HMO) Medicare Star Ratings English (PDF, 112 KB) / Español (PDF, 152 KB)

    Blue Shield AdvantageOptiumum Plan (HMO) and AdvantageOptiumum Plan 1 (HMO) Medicare Star Ratings English (PDF, 171 KB) / Español (PDF, 175 KB)

    Blue Shield PPO Medicare Star Ratings English (PDF, 169 KB) / Español (PDF, 179 KB)

    *Every year, Medicare evaluates plans based on a 5-star rating system.

Please refer to our list of compatible browsers when downloading or viewing PDF documents.

Y0118_22_335A2_M Accepted 10092022
Page last updated: 10/14/2022

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