For members

For providers

For employers

2025 Medicare materials such as the Evidence of Coverage, pharmacy directories, FAQ’s, and star rating are coming soon. If you have any questions, please contact your Broker Manager
When viewing client list today: 'Plan change is in progress' status indicates the subscriber's current year plan coverage ends 06/30/26 and their renewed or upcoming plan year coverage is effective 7/1/2026. Once 2026 plan coverage is effective, status will move to 'Current'.

When viewing Medicare client list today: 'Plan change is in progress' status indicates the subscriber's current year plan coverage ends 06/30/26 and their renewed or upcoming plan year coverage is effective 7/1/2026. Once 2026 plan coverage is effective, status will move to 'Current'.

2027 Medicare Broker Certification is available July 15, 2026. Submit your AHIP or NABIP transcript to Blue Shield before attempting the exam Learn more

Help MA-PD clients

Here are PDF resources that can help you manage your existing Blue Shield of California MA-PD (HMO, HMO D-SNP, and PPO) clients in our plans for Medicare beneficiaries.

Including:

Evidence of Coverage documents
Star ratings
Pharmacy directories
Formularies
Dental flyer and dental enrollment forms
Authorization for the Use or Disclosure of Health Information
Over-the-counter (OTC) items catalog
Change of plan and disenrollment forms

Please note:

All provider directories and materials you need for enrollment are located on the Arvato Storefront

The following browsers have been found to provide the best experience on the Blue Shield of California website: Google Chrome, Safari, Microsoft Edge, or Mozilla Firefox.

2027 Blue Shield Inspire (HMO) Evidence of Coverage

2027 Blue Shield Inspire (HMO) – Los Angeles and Orange counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield Inspire (HMO) – Alameda and San Mateo counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield Inspire (HMO) – San Joaquin, Stanislaus, Merced, and Santa Clara counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)

2027 Blue Shield 65 Plus (HMO) Evidence of Coverage

2027 Blue Shield 65 Plus (HMO) – Los Angeles and Orange counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus (HMO) – San Bernardino County	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus (HMO) – Riverside County	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus Choice Plan (HMO) – Riverside and San Bernardino counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus (HMO) – San Diego County	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus (HMO) – Kern County	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)

2027 Blue Shield Advantage (HMO) Evidence of Coverage

2027 Blue Shield Advantage (HMO) – San Joaquin County	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield Advantage (HMO) – Sacramento and Placer Counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield Advantage (HMO) – Los Angeles and Orange counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield Advantage (HMO) – San Diego County	English (PDF, 42 KB) Spanish (PDF, 42 KB)

2027 Blue Shield Value Advantage Plan (HMO) Evidence of Coverage

2027 Blue Shield Value Advantage Plan (HMO) – Los Angeles County	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield Value Advantage Plan (HMO) – San Diego County	English (PDF, 42 KB) Spanish (PDF, 42 KB)

2027 Blue Shield AdvantageOptimum Plan (HMO) Evidence of Coverage

2027 Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties	English (PDF, 42 KB) Spanish (PDF, 42 KB)
2027 Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County	English (PDF, 42 KB) Spanish (PDF, 42 KB)

2027 Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP) Evidence of Coverage

2027 Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP) – Los Angeles and San Diego counties

English (PDF, 42 KB)
Español (PDF, 42 KB)
Arabic (PDF, 42 KB)
Armenian (PDF, 42 KB)
Chinese (Simplified) (PDF, 42 KB)
Chinese (Traditional) (PDF, 42 KB)
Farsi (PDF, 42 KB)
Khmer (PDF, 42 KB)
Korean (PDF, 42 KB)
Russian (PDF, 42 KB)
Tagalog (PDF, 42 KB)
Vietnamese (PDF, 42 KB)

2027 Star ratings

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield Inspire (HMO), Blue Shield Advantage (HMO), Blue Shield Value Advantage Plan (HMO)	English (PDF, 212 KB) Spanish (PDF, 115 KB)
Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP) Medicare Star Ratings¹	English (PDF, 190 KB) Spanish (PDF, 188 KB) Arabic (PDF, 276 KB) Armenian (PDF, 212 KB) Chinese (Simplified) (PDF, 272 KB) Chinese (Traditional) (PDF, 266 KB) Farsi (PDF, 275 KB) Khmer (PDF, 220 KB) Korean (PDF, 295 KB) Russian (PDF, 266 KB) Tagalog (PDF, 185 KB) Vietnamese (PDF, 341 KB)
Blue Shield AdvantageOptimum Plan (HMO) and Blue Shield AdvantageOptimum Plan 1 (HMO) Medicare Star Ratings*	English (PDF, 182 KB) Spanish (PDF, 198 KB)

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

2027 Pharmacy directory

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield AdvantageOptimum Plan (HMO), Blue Shield AdvantageOptimum Plan 1 (HMO), Blue Shield Inspire (HMO), Blue Shield Advantage (HMO), Blue Shield Value Advantage Plan (HMO)	English (PDF, 6 MB) Spanish (PDF, 6.4 MB)
Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP) Los Angeles/San Diego counties	English (PDF, 4.5 MB) Español (PDF, 4.3 MB) Chinese (Simplified) (PDF, 4.7 MB) Chinese (Traditional) (PDF, 4.5 MB) Arabic (PDF, 4.4 MB) Armenian (PDF, 4.5 MB) Farsi (PDF, 4.4 MB) Khmer (PDF, 4.1 MB) Korean (PDF, 4.1 MB) Russian (PDF, 4 MB) Tagalog (PDF, 4.5 MB) Vietnamese (PDF, 4.6 MB)

2027 MA-PD formularies

Blue Shield 65 Plus (HMO) – Los Angeles County, Orange County, San Bernardino County & San Diego County

Blue Shield 65 Plus (HMO) – Kern County & Riverside County

Blue Shield 65 Plus (HMO) – San Luis Obispo County & Santa Barbara County

Blue Shield 65 Plus Choice Plan (HMO) – San Bernardino County & Riverside County

Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles County & Orange County

Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles County & Orange County

Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County

Blue Shield Inspire (HMO) – Alameda County, San Mateo County, San Joaquin County, Stanislaus County, Merced County & Santa Clara County

Blue Shield Inspire (HMO) – Los Angeles County & Orange County

Blue Shield Advantage (HMO) – Placer County, Sacramento County & San Joaquin County

Blue Shield Advantage (HMO) – Los Angeles County, Orange County & San Diego County

Blue Shield Value Advantage Plan (HMO) – Los Angeles County & San Diego County

Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP) – Los Angeles County & San Diego County

2027 Dental flyers and forms

2027 Optional supplemental dental HMO and INO plan flyer	English (PDF, 176 KB) Spanish (PDF, 245 KB)
2027 Optional supplemental dental HMO and INO plan enrollment form	English (PDF, 82 KB) Spanish (PDF, 42 KB)
2027 D-SNP dental guide	English (PDF, 472 KB) Spanish (PDF, 428 KB)

Authorization for the Use or Disclosure of Health Information

English (PDF, 160 KB)
Español (PDF, 129 KB)
Arabic (PDF, 191 KB)
Armenian (PDF, 172 KB)
Cambodian (PDF, 184 KB)
Chinese (Simplified) (PDF, 291 KB)
Chinese (Traditional) (PDF, 187 KB)
Farsi (PDF, 191 KB)
Korean (PDF, 183 KB)
Russian (PDF, 225 KB)
Tagalog (PDF, 129 KB)
Vietnamese (PDF, 256 KB)

2027 Over-The-Counter (OTC) items catalog

2027 MA-PD Plans with the OTC Items Benefit:

Blue Shield Inspire (HMO) – Los Angeles, Orange, Alameda, San Mateo, Santa Clara, San Joaquin, Stanislaus, and Merced counties
Blue Shield 65 Plus (HMO) – Kern and San Diego counties
Blue Shield 65 Plus Choice Plan (HMO) – San Bernardino and Riverside counties
Blue Shield Advantage (HMO) – San Joaquin, Sacramento, Placer, Los Angeles, Orange, and San Diego counties
Blue Shield Value Advantage Plan (HMO) – Los Angeles and San Diego Counties
Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP) – Los Angeles and San Diego counties

OTC Catalog

English (PDF, 42 KB)

2027 Change of plan and disenrollment forms

MA-PD (HMO) Change of Plan forms	English (PDF, 121 KB) Spanish (PDF, 42 KB) Chinese (Traditional) (PDF, 42 KB) Korean (PDF, 42 KB) Vietnamese (PDF, 42 KB) Armenian (PDF, 42 KB)
MA-PD (Medicare + Medi-Cal HMO D-SNP) Change of Plan forms	English (PDF, 106 KB) Spanish (PDF, 42 KB) Arabic (PDF, 42 KB) Armenian (PDF, 42 KB) Cambodian (PDF, 42 KB) Chinese (Simplified) (PDF, 42 KB) Chinese (Traditional) (PDF, 42 KB) Farsi (PDF, 42 KB) Korean (PDF, 42 KB) Russian (PDF, 42 KB) Tagalog (PDF, 42 KB) Vietnamese (PDF, 42 KB)
MA-PD Disenrollment forms	English (PDF, 64 KB) Spanish (PDF, 42 KB) Arabic (PDF, 42 KB) Armenian (PDF, 42 KB) Cambodian (PDF, 42 KB) Chinese (Simplified) (PDF, 42 KB) Chinese (Traditional) (PDF, 42 KB) Farsi (PDF, 42 KB) Korean (PDF, 42 KB) Russian (PDF, 42 KB) Tagalog (PDF, 42 KB) Vietnamese (PDF, 42 KB)
Optional Supplemental dental disenrollment forms	English (PDF, 53 KB) Spanish (PDF, 42 KB)
PDP Change of plan form	English (PDF, 213 KB) Spanish (PDF, 42 KB)
PDP disenrollment form	English (PDF, 94 KB) Spanish (PDF, 42 KB)

2026 Blue Shield Inspire (HMO) Evidence of Coverage

2026 Blue Shield Inspire (HMO) – Los Angeles and Orange counties	English (PDF, 1.7 MB) Spanish (PDF, 2 MB)
2026 Blue Shield Inspire (HMO) – Alameda and San Mateo counties	English (PDF, 1.9 MB) Spanish (PDF, 2 MB)
2026 Blue Shield Inspire (HMO) – San Joaquin, Stanislaus, Merced, and Santa Clara counties	English (PDF, 1.8 MB) Spanish (PDF, 2 MB)

2026 Blue Shield 65 Plus (HMO) Evidence of Coverage

2026 Blue Shield 65 Plus (HMO) – Los Angeles and Orange counties	English (PDF, 1.8 MB) Spanish (PDF, 2 MB)
2026 Blue Shield 65 Plus (HMO) – San Bernardino County	English (PDF, 1.8 MB) Spanish (PDF, 2 MB)
2026 Blue Shield 65 Plus (HMO) – Riverside County	English (PDF, 1.7 MB) Spanish (PDF, 2 MB)
2026 Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties	English (PDF, 1.8 MB) Spanish (PDF, 2 MB)
2026 Blue Shield 65 Plus Choice Plan (HMO) – Riverside and San Bernardino counties	English (PDF, 1.8 MB) Spanish (PDF, 2.2 MB)
2026 Blue Shield 65 Plus (HMO) – San Diego County	English (PDF, 1.9 MB) Spanish (PDF, 2 MB)
2026 Blue Shield 65 Plus (HMO) – Kern County	English (PDF, 1.7 MB) Spanish (PDF, 1.9 MB)
2026 Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties	English (PDF, 1.8 MB) Spanish (PDF, 2 MB)

2026 Blue Shield Advantage (HMO) Evidence of Coverage

2026 Blue Shield Advantage (HMO) – San Joaquin County

English (PDF, 1.7 MB)
Spanish (PDF, 2.1 MB)

2026 Blue Shield AdvantageOptimum Plan (HMO) Evidence of Coverage

2026 Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties	English (PDF, 1.7 MB) Spanish (PDF, 1.9 MB)
2026 Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County	English (PDF, 1.7 MB) Spanish (PDF, 1.9 MB)

2026 Blue Shield TotalDual Plan (HMO D-SNP) Evidence of Coverage

2026 Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties

English (PDF, 3.4 MB)
Español (PDF, 4.7 MB)
Arabic (PDF, 5.3 MB)
Armenian (PDF, 5.1 MB)
Chinese (Simplified) (PDF, 4.5 MB)
Chinese (Traditional) (PDF, 6.4 MB)
Farsi (PDF, 5.8 MB)
Khmer (PDF, 11.7 MB)
Korean (PDF, 13.1 MB)
Russian (PDF, 3.8 MB)
Tagalog (PDF, 5.7 MB)
Vietnamese (PDF, 4.3 MB)

2026 Star ratings

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield Inspire (HMO), Blue Shield Advantage (HMO)	English (PDF, 212 KB) Spanish (PDF, 115 KB)
Blue Shield TotalDual Plan (HMO D-SNP) Medicare Star Ratings*	English (PDF, 190 KB) Spanish (PDF, 188 KB) Arabic (PDF, 276 KB) Armenian (PDF, 212 KB) Chinese (Simplified) (PDF, 272 KB) Chinese (Traditional) (PDF, 266 KB) Farsi (PDF, 275 KB) Khmer (PDF, 220 KB) Korean (PDF, 295 KB) Russian (PDF, 266 KB) Tagalog (PDF, 185 KB) Vietnamese (PDF, 341 KB)
Blue Shield AdvantageOptimum Plan (HMO) and Blue Shield AdvantageOptimum Plan 1 (HMO) Medicare Star Ratings*	English (PDF, 182KB) Spanish (PDF, 198 KB)

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

2026 Pharmacy directory

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield AdvantageOptimum Plan (HMO), Blue Shield AdvantageOptimum Plan 1 (HMO), Blue Shield Inspire (HMO), Blue Shield Advantage (HMO)	English (PDF, 2.5 MB) Spanish (PDF, 2.8 MB)
Blue Shield TotalDual Plan (HMO D-SNP) Los Angeles/San Diego counties	English (PDF, 4.6 MB) Español (PDF, 3.4 MB) Chinese (Simplified) (PDF, 3.9 MB) Chinese (Traditional) (PDF, 3.5 MB) Arabic (PDF, 4 MB) Armenian (PDF, 3.4 MB) Farsi (PDF, 3.8 MB) Khmer (PDF, 3.8 MB) Korean (PDF, 3.4 MB) Russian (PDF, 3.9 MB) Tagalog (PDF, 4.8 MB) Vietnamese (PDF, 5.8 MB)

2026 MA-PD formularies

Blue Shield 65 Plus (HMO) – Los Angeles, Orange, San Bernardino, and San Diego counties

Blue Shield 65 Plus (HMO) – Kern and Riverside counties

Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties

Blue Shield 65 Plus Choice Plan (HMO) – San Bernardino and Riverside counties

Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties

Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties

Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County

Blue Shield Inspire (HMO) – Alameda, San Mateo, San Joaquin, Stanislaus, Merced, and Santa Clara counties

Blue Shield Inspire (HMO) – Los Angeles and Orange counties

Blue Shield Advantage (HMO) – San Joaquin County

Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties

2026 Dental flyers and forms

2026 Optional supplemental dental HMO and PPO plan flyer	English (PDF, 93 KB) Spanish (PDF, 90 KB)
2026 Optional supplemental dental HMO and PPO plan enrollment form	English (PDF, 76 KB) Spanish (PDF, 77 KB)
D-SNP dental guide	English (PDF, 392 KB) Español (PDF, 397 KB)

Authorization for the Use or Disclosure of Health Information

2026 Over-The-Counter (OTC) items catalog

2026 MA-PD Plans with the OTC Items Benefit:

Blue Shield Inspire (HMO) – Los Angeles, Orange, Alameda, San Mateo, Santa Clara, San Joaquin, Stanislaus, and Merced counties
Blue Shield Advantage (HMO) - San Joaquin County
Blue Shield 65 Plus (HMO) – Kern and San Diego counties
Blue Shield 65 Plus Choice Plan (HMO) – San Bernardino and Riverside counties
Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties
Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County
Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties

OTC Catalog

English (PDF, 43 KB)
Spanish (PDF, 43 KB)
Chinese (Traditional) (PDF, 43 KB)
Korean (PDF, 43 KB)
Vietnamese (PDF, 43 KB)

2026 Change of plan and disenrollment forms

MA-PD (HMO) Change of Plan forms	English (PDF, 105 KB) Spanish (PDF, 112 KB) Chinese (Traditional) (PDF, 245 KB) Korean (PDF, 207 KB) Vietnamese (PDF, 259 KB) Armenian (PDF, 156 KB)
MA-PD (TotalDual HMO D-SNP) Change of Plan forms	English (PDF, 98 KB) Spanish (PDF, 102 KB) Arabic (PDF, 253 KB) Armenian (PDF, 99 KB) Cambodian (PDF, 161 KB) Chinese (Simplified) (PDF, 272 KB) Chinese (Traditional) (PDF, 111 KB) Farsi (PDF, 205 KB) Korean (PDF, 200 KB) Russian (PDF, 233 KB) Tagalog (PDF, 98 KB) Vietnamese (PDF, 243 KB)
MA-PD Disenrollment forms	English (PDF, 56 KB) Spanish (PDF, 96 KB) Arabic (PDF, 213 KB) Armenian (PDF, 123 KB) Cambodian (PDF, 149 KB) Chinese (Simplified) (PDF, 167 KB) Chinese (Traditional) (PDF, 149 KB) Farsi (PDF, 232 KB) Korean (PDF, 138 KB) Russian (PDF, 179 KB) Tagalog (PDF, 98 KB) Vietnamese (PDF, 159 KB)
Optional Supplemental dental disenrollment forms	English (PDF, 44 KB) Spanish (PDF, 80 KB)

The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. La compañía cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, país de origen, identificación con determinado grupo étnico, condición médica, información genética, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad, ni discapacidad física ni mental. 本公司遵守適用的州法律和聯邦民權法律，並且不會以種族、膚色、原國籍、族群認同、醫療狀況、遺傳資訊、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡、精神殘疾或身體殘疾而進行歧視、排斥或區別對待他人。

Y0118_26_179E_C 08062026
H2819_26_179E_C 08062026

Page last updated: 10/1/2026

All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.