Medicare Supplement Application Forms

Who is this for?

If you want to apply for a Medicare Supplement or MyBlue Medigap plan, you can find the form here.

What you'll need to apply:

Mail the application form to:

Blue Cross Blue Shield of Michigan
P.O. Box 44407
Detroit, MI 48244-0407
Fax: 1-866-392-7528

Things to remember:

  • If you're enrolled in a Medicare Advantage plan, make sure you disenroll from that plan before you enroll in a Medicare supplement plan. You can find out how to disenroll from Medicare Advantage in our help center.
  • If you have any other health insurance coverage, don't cancel your plan until you get your new ID card and welcome packet.
  • If you're enrolling outside a special enrollment period, you'll need to list your recent medical history and the prescription drugs you're taking on your enrollment form.
  • Medicare supplement plans that cover the Part B deductible (Plans C, F, and high‑deductible F) will no longer be available for individuals who turn 65 or become eligible for Medicare on or after January 1, 2020. In response, Blue Cross now offers Plan G (PDF).