Forms and Documents

Change Plan Forms 
These forms will be helpful if you need to change your Michigan Medicare plan or add dental and vision coverage to your BCN Advantage plan.

Pharmacy Forms 
These forms will help you manage your prescription drug coverage.

Payment Forms 
Use this form to have your Medicare Advantage or Part D plan premiums taken out of your bank account.

Claim Forms 
Use these forms to ask us to pay you back for medical expenses, like prescriptions or out-of-network doctors costs.

Enrollment Forms 
Find enrollment forms for our Medicare Advantage, Medicare Supplement and PDP plans here.

Appointment of Representative Form 
Michigan Medicare members can use this form to choose a representative for their medical decisions. Download it here.

Drug Lists and Formularies 
Need to know if your Medicare plan covers a specific prescription drug? You can use the drug list, also called a formulary, to find out.

Find a Doctor 
Are you looking for a list of doctors, hospitals and specialists that accept Medicare patients? Use our Find a Doctor tool.

Pharmacy Directory 
If you have prescription drug coverage through your Medicare plan, read this article for tips on finding a pharmacy.

Summary of Benefits 
You can use this document to compare it to other plans and see key features, including cost, benefits, deductibles, copays.

Evidence of Coverage 
Your evidence of coverage book is like an instruction manual for your Michigan Medicare Advantage plan. Find your 2018 book here.

Health Plan Ratings 
Want to know which Michigan Medicare plans have the best quality? See government ratings to find out which coverage might be best for you.

Service Area Maps 
Want to know where you can get Medicare coverage in Michigan? These service area maps can help.

Low-Income Subsidy Premium Charts 
Learn more about the monthly LIS premiums for Michigan Medicare plans.