2027 Medicare Advantage Prescription Drug Plan Documents
Your Blue Shield of California Medicare Advantage plan documents are listed on this page. Here are a few key 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 outlines 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 every January 1.
For information on members and Blue Shield of California’s rights and responsibilities upon disenrollment, please refer to Chapter 10 in your EOC linked below.
Blue Shield 65 Plus (HMO)
Blue Shield 65 Plus (HMO) – Los Angeles and Orange counties
Evidence of Coverage (EOC): English (PDF, 2.6 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 835 KB) / Español (PDF, 326 KB)
Annual Notice of Changes: English (PDF, 1.6 MB) / Español (PDF, 5.1 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus (HMO) – Kern County
Evidence of Coverage (EOC): English (PDF, 2.3 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 740 KB) / Español (PDF, 612 KB)
Annual Notice of Changes: English (PDF, 1.6 MB) / Español (PDF, 3.3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus (HMO) – Riverside County
Evidence of Coverage (EOC): English (PDF, 3.8 MB) / Español (PDF, 2 MB)
Summary of Benefits (SOB): English (PDF, 735 KB) / Español (PDF, 1.2 MB)
Annual Notice of Changes: English (PDF, 1.1 MB) / Español (PDF, 814 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus (HMO) – San Bernardino County
Evidence of Coverage (EOC): English (PDF, 4.1 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 848 KB) / Español (PDF, 735 KB)
Annual Notice of Changes: English (PDF, 1.1 MB) / Español (PDF, 1.7 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus (HMO) – San Diego County
Evidence of Coverage (EOC): English (PDF, 3.7 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 764 KB) / Español (PDF, 1.1 MB)
Annual Notice of Changes: English (PDF, 1.6 MB) / Español (PDF, 3.3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus (HMO) – Santa Barbara and San Luis Obispo counties
Evidence of Coverage (EOC): English (PDF, 2.4 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 717 KB) / Español (PDF, 305 KB)
Annual Notice of Changes: English (PDF, 912 KB) / Español (PDF, 4.1 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus Choice Plan (HMO) – San Bernardino and Riverside counties
Evidence of Coverage (EOC): English (PDF, 3.6 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 828 KB) / Español (PDF, 653 KB)
Annual Notice of Changes: English (PDF, 3 MB) / Español (PDF, 1.3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties
Evidence of Coverage (EOC): English (PDF, 2.4 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 693 KB) / Español (PDF, 345 KB)
Annual Notice of Changes: English (PDF, 1.2 MB) / Español (PDF, 921 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Inspire (HMO)
Blue Shield Inspire (HMO) – Alameda and San Mateo counties
Evidence of Coverage (EOC): English (PDF, 3.7 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 740 KB) / Español (PDF, 713 KB)
Annual Notice of Changes: English (PDF, 1.2 MB) / Español (PDF, 4.9 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Inspire (HMO) – San Joaquin, Stanislaus, Merced, and Santa Clara counties
Evidence of Coverage (EOC): English (PDF, 3.6 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 762 KB) / Español (PDF, 732 KB)
Annual Notice of Changes: English (PDF, 833 KB) / Español (PDF, 3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Inspire (HMO) – Los Angeles and Orange counties
Evidence of Coverage (EOC): English (PDF, 2.6 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 744 KB) / Español (PDF, 711 KB)
Annual Notice of Changes: English (PDF, 1.5 MB) / Español (PDF, 3.8 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Advantage (HMO)
Blue Shield Advantage (HMO) - San Joaquin County
Evidence of Coverage (EOC): English (PDF, 3.1 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 754 KB) / Español (PDF, 651 KB)
Annual Notice of Changes: English (PDF, 1.3 MB) / Español (PDF, 4.8 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Advantage (HMO) – Sacramento and Placer County
Evidence of Coverage (EOC): English (PDF, 2.7 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 864 KB) / Español (PDF, 886 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Advantage (HMO) – Los Angeles and Orange County
Evidence of Coverage (EOC): English (PDF, 3.3 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 750 KB) / Español (PDF, 602 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Advantage (HMO) – San Diego County
Evidence of Coverage (EOC): English (PDF, 3.1 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 763 KB) / Español (PDF, 780 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Value Advantage Plan (HMO)
Blue Shield Value Advantage Plan (HMO) – Los Angeles County
Evidence of Coverage (EOC): English (PDF, 2.3 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 860 KB) / Español (PDF, 978 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield Value Advantage Plan (HMO) – San Diego County
Evidence of Coverage (EOC): English (PDF, 2.3 MB) / Español (PDF, 2.2 MB)
Summary of Benefits (SOB): English (PDF, 876 KB) / Español (PDF, 866 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield AdvantageOptimum Plan (HMO)
Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties
Evidence of Coverage (EOC): English (PDF, 2.1 MB) / Español (PDF, 2.1 MB)
Summary of Benefits (SOB): English (PDF, 714 KB) / Español (PDF, 525 KB)
Annual Notice of Changes: English (PDF, 963 MB) / Español (PDF, 3.1 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County
Evidence of Coverage (EOC): English (PDF, 2.1 MB) / Español (PDF, 2 MB)
Summary of Benefits (SOB): English (PDF, 619 KB) / Español (PDF, 686 KB)
Annual Notice of Changes: English (PDF, 937 KB) / Español (PDF, 769 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 201 KB) / Chinese (Traditional) (PDF, 313 KB) / Korean (PDF, 278 KB) / Vietnamese (PDF, 331 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)
Notice of Availability of Language Services and Auxiliary Aids and Services, Nondiscrimination notice, and Blue Shield MA-PD star ratings
Notice of Availability of Language Services and Auxiliary Aids and Services and Nondiscrimination notice
Blue Shield Medicare Advantage Prescription Drug Plans Notice of Availability of Language Assistance Services and Auxiliary Aids and Services:
English (PDF, 1.3 MB)
Blue Shield Medicare Advantage Prescription Drug Plans Nondiscrimination notice:
English (PDF, 420 KB) / Español (PDF, 617 KB) / Chinese (Simplified) (PDF, 614 KB) / Chinese (Traditional) (PDF, 669 KB)
Blue Shield MA-PD Star ratings
Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), and Blue Shield Inspire (HMO), Blue Shield Advantage (HMO), Blue Shield Value Advantage Plan (HMO) Medicare Star Ratings*
English (PDF, 212 KB)
Español (PDF, 115 KB)
Blue Shield AdvantageOptimum Plan (HMO) and AdvantageOptimum Plan 1 (HMO) Medicare Star Ratings¹
English (PDF, 182 KB) / Español (PDF, 198 KB)
1 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.
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 Service at (800) 776-4466 (TTY: 711), 8 a.m. to 8 p.m. Pacific Time, seven days a week.
- Blue Shield of California Dual Special Needs Plans Customer Service at (800) 452-4413, 8 a.m. to 8 p.m. Pacific time, seven days a week.
For help in your language, please review the Notice of Availability of Language Assistance Services and Auxiliary Aids and Services and the Nondiscrimination notice located on this page.
Blue Shield of California is an HMO, HMO D-SNP, and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.
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Page last updated: 10/06/2026