Medicare Plan Enrollment Forms

The easiest way to enroll in a Blue Cross Blue Shield of Michigan Medicare plan is to sign up online. But if you'd rather use an enrollment form, you can find one here.

You can enroll online for any of our Medicare plans.

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2026 Medicare Plus Blue ℠ PPO Secure, Vitality, Signature and Assure Enrollment Form

Download and fill out this form if you'd like to enroll in a 2026 Medicare Plus Blue PPO Secure, Vitality, Signature or Assure plan.

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2026 Medicare Plus Blue ℠ PPO Value, Vitality, Signature and Assure Enrollment Form

Download and fill out this form if you'd like to enroll in a 2026 Medicare Plus Blue PPO Value, Vitality, Signature or Assure plan.

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2026 Medicare Plus Blue ℠ PPO Giveback Enrollment Form

Download and fill out this form if you'd like to enroll in a 2026 Medicare Plus Blue PPO Giveback plan.

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2026 Medicare Plus Blue ℠ PPO Essential and +Meijer Enrollment Form

Download and fill out this form if you'd like to enroll in a 2026 Medicare Plus Blue PPO Essential or +Meijer plan.

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2026 Medicare Plus Blue PPO Dental and Vision Plan Enrollment Form

Download and fill out this form to add dental and vision coverage to your 2026 Medicare Plus Blue PPO plan.

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2026 Medicare Plus Blue PPO Plan Change Form

If you have another one of our Medicare Advantage plans and want to switch to a PPO plan for 2026, use this form.

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2026 BCN Advantage HMO ConnectedCare Enrollment Form

Download and fill out this form if you'd like to enroll in 2026 BCN Advantage HMO ConnectedCare.

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2026 HMO Dental, Vision and Hearing Plan Enrollment Form

Download and fill out this form to add dental, vision and hearing coverage to your 2026 HMO plan.

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2026 HMO Plan Change Form

If you have another one of our Medicare Advantage plans and want to switch to an HMO plan for 2026, use this form.

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2026 HMO-POS Classic and Prestige Enrollment Form

Download and fill out this form if you'd like to enroll in 2026 BCN Advantage HMO-POS Classic or Prestige.

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2026 HMO-POS Elements Enrollment Form

Download and fill out this form if you'd like to enroll in 2026 BCN Advantage HMO-POS Elements.

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2026 HMO-POS Prime Value Enrollment Form

Download and fill out this form if you'd like to enroll in 2026 BCN Advantage HMO-POS Prime Value.

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2026 HMO-POS Dental and Vision Plan Enrollment Form

Download and fill out this form to add dental and vision coverage to your 2026 HMO-POS plan.

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2026 HMO-POS Plan Change Form for 2026

If you have another one of our Medicare Advantage plans and want to switch to an HMO-POS plan for 2026, use this form.

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2026 Prescription Blue PDP Enrollment Form

Download and fill out this form if you'd like to enroll in one of our 2026 Part D plans, Prescription Blue PDP Select or Premium.

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2026 Prescription Blue PDP Plan Change Form

If you have another one of our plans and want to switch to a PDP plan in 2026, use this form.

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Medicare Supplement Application Form for 2026

Download and fill out this form if you'd like to enroll in one of our 2026 Medicare supplement plans.

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Medicare Supplement Outline of Coverage for 2026

Download this document to get a detailed comparison of coverage for each of our 2026 Medicare supplement plans.

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Medicare Supplement Dental Vision Hearing Package Application Form

Download and fill out this form if you'd like to add dental, vision and hearing coverage to your Blue Cross Medicare Supplement plan.

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Medicare Supplement Dental Vision Hearing Package Disenrollment Form

If you're currently enrolled in the Dental Vision Hearing Package for a Medicare supplement plan and would like to cancel your coverage, fill out this form.

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Application for Medicare Supplement Household Discount

If you and someone you live with both have a Blue Cross Blue Shield of Michigan Medicare Supplement or Legacy Medigap plan, you might be eligible for a household discount. The discount saves you 10% on your monthly premium.

Important information about Medicare supplement plans

This is a solicitation of insurance. We may contact you about buying insurance. Blue Cross Medicare SupplementSM plans aren't connected with or endorsed by the U.S. government or the federal Medicare program.

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  • Page Last Updated Tue Jun 16 22:21:04 UTC 2026