Medicare Plus Blue PPO Essential | Members

Plan details and benefits

Summary of Benefits (PDF)

Read about the benefits that come with your plan.
Evidence of Coverage (PDF)

Learn how your plan works.
Annual Notice of Change (PDF)

Read about how this plan has changed since last year.
Covered Drug List (PDF)

Learn which drugs your plan covers and if there are requirements or quantity limits.
Covered Drug List Updates (PDF)

Read a list of changes made to this formulary since its initial release.
Drug Prior Authorization and Step Therapy List (PDF)

See which medications require prior authorization or step therapy for this plan.
Low Income Subsidy (PDF)

Learn what your monthly premium might be if you qualify for Extra Help from Medicare.
Star Rating (PDF)

Medicare rates plans based on quality and performance every year. Called Medicare Star Ratings, these documents show you how well a plan is performing.
Coverage Map (PDF)

Learn where you must live to buy this plan.

Find the form you need to submit a claims reimbursement, coverage determination and more.

You can add extra dental and vision coverage to your Medicare Advantage plan for an additional monthly cost. This package includes:

Extra coverage for dental work including dentures, bridges and implants.
A generous allowance for elective contact lenses or glasses (lenses and frames). Polycarbonate lenses and anti reflective coating are covered in network.

You'll see your plan's benefits, cost estimates and other details.