It's easy to enroll in our individual Prescription Blue PDP plans. Enroll now, or use the Prescription Blue PDP enrollment form to sign up for either of our two Prescription BlueSM PDP plans. Read the Pre-enrollment brochure, then refer to the Summary of Benefits for a description of each plan. For detailed benefit information, refer to Evidence of Coverage. Remember, regardless of the plan you choose, you must continue to pay your Medicare Part B premium.
|Enrollment Information and Forms|
|Prescription Blue PDP pre-enrollment brochure||Pre-enrollment brochure (PDF)|
|Prescription Blue PDP Enrollment Application form||Enrollment Application form (PDF)|
|Automatic Deduction form||Automatic Deduction form (PDF)|
Download Enrollment Application form
Please select the Prescription Blue PDP Enrollment Application form from the list above. Fill out the form and be sure to make a copy of it to save for your records. Put the form in a stamped 9" x 11" envelope and send it to us at:
Blue Cross Blue Shield of Michigan
Prescription Blue PDP Enrollment
P.O. Box 44828
Detroit, MI 48244-0256
For more information contact Prescription Blue PDP at 1-888-563-3307 (TTY users call 711) from 8 a.m. to 9 p.m. Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14.
Also, you can visit our Member Services locations.
You may request the Prescription Blue PDP enrollment form in alternative formats by calling 1-888-563-3307 from 8 a.m. to 9 p.m. Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14. TTY users call 711.
Medicare beneficiaries may also enroll in Prescription Blue PDP through the Centers for Medicare and Medicaid Services Online Enrollment Center, located at www.medicare.gov.
- Do not send us your enrollment form until Oct. 15.
- You will need one form for each person enrolling in a plan.
- You can only enroll in one plan.
- Do not enclose payment with your enrollment form. We'll bill you.
- If you request automatic deduction (use the form above), we'll automatically deduct your premium from your bank account. Social Security deductions can also be arranged after you have received a member ID card.
- If you currently have Medicare supplemental and/or prescription drug coverage from an employer group or union and are considering enrolling in Prescription Blue PDP, call your group benefits representative first to determine if you need this coverage.
To complete an Enrollment Application form we sent you:
If you received an enrollment form in the mail from us, please fill it out completely. Be sure to check which plan you want to enroll in and save a copy for your records. Put the completed enrollment form (do not fold it) in the 9" x 11" postage-paid envelope we sent you and mail it back to us. If you have not received this enrollment form, you can call us for one or download the appropriate enrollment form from this website.