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2027 Medicare Advantage Prescription Drug Plan Documents

2026 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.6 MB) / Español (PDF, 5.1 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.1 MB) / Español (PDF, 814 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.1 MB) / Español (PDF, 814 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.1 MB) / Español (PDF, 1.7 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.6 MB) / Español (PDF, 3.3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 912 KB) / Español (PDF, 4.1 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 3 MB) / Español (PDF, 1.3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.2 MB) / Español (PDF, 921 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.2 MB) / Español (PDF, 4.9 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 833 KB) / Español (PDF, 3 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.5 MB) / Español (PDF, 3.8 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 1.3 MB) / Español (PDF, 4.8 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 KB)
Pre-enrollment Checklist: English (PDF, 247 KB) / Español (PDF, 142 KB)

Blue Shield Advantage (HMO) – Los Angeles and Orange County

Blue Shield Advantage (HMO) – San Diego County

Blue Shield Value Advantage Plan (HMO)

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

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

Blue Shield AdvantageOptimum Plan (HMO)

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

Evidence of Coverage (EOC): English (PDF, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 963 MB) / Español (PDF, 3.1 MB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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, 42 KB) / Español (PDF, 42 KB)
Summary of Benefits (SOB): English (PDF, 42 KB) / Español (PDF, 42 KB)
Annual Notice of Changes: English (PDF, 937 KB) / Español (PDF, 769 KB)
Enrollment Form: English (PDF, 182 KB) / Español (PDF, 165 KB) / Chinese (Traditional) (PDF, 42 KB) / Korean (PDF, 42 KB) / Vietnamese (PDF, 42 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.

Y0118_26_179D_C Accepted 08222026
H2819_26_179D_C Accepted 08222026

Page last updated: 10/1/2026

* Blue Shield Medicare Advisors are available October 1 through March 31 from 8 a.m. to 8 p.m. PT, seven days a week and April 1 through September 30 from 8 a.m. to 8 p.m. PT on weekdays.

† All downloads are free with no obligation to enroll. .

Blue Shield of California is an independent member of the Blue Shield Association.

Blue Shield of California 601 12th Street, Oakland, CA 94607.

Nondiscrimination Notice

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。