2021 Annual Notice of Change/Evidence of Coverage
The Evidence of Coverage booklet tells you how to get your Medicare medical care and prescription drugs (if applicable) through a Medicare Advantage plan.
The Evidence of Coverage booklet explains:
- Member rights and responsibilities
- What is covered
- What you will pay as a member of the plan
The benefits listed in the Evidence of Coverage are effective January 1 of the current year. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1, 2021.
Medicare Advantage HMO Plans
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2021 BlueSaver (HMO) Annual Notice of Change Last updated October 1, 2020
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2021 BlueSaver (HMO) Evidence of Coverage Last updated October 1, 2020
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2021 Senior Blue Select (HMO) Annual Notice of Change Last updated November 25, 2020
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2021 Senior Blue Select (HMO) Evidence of Coverage Last updated November 25, 2020
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2021 Senior Blue 601 (HMO) Annual Notice of Change Last updated October 1, 2020
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2021 Senior Blue 601 (HMO) Evidence of Coverage Last updated October 1, 2020
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2021 Senior Blue 651 (HMO) Annual Notice of Change Last updated October 1, 2020
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2021 Senior Blue 651 (HMO) Evidence of Coverage Last updated October 1, 2020
Medicare Advantage PPO Plans
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2021 Forever Blue Value (PPO) Annual Notice of Change Last updated October 1, 2020
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2021 Forever Blue Value (PPO) Evidence of Coverage Last updated October 1, 2020
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2021 Forever Blue 751 (PPO) Annual Notice of Change Last updated October 1, 2020
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2021 Forever Blue 751 (PPO) Evidence of Coverage Last updated October 1, 2020
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2021 Freedom Nation (PPO) Evidence of Coverage Last updated October 1, 2020
Optional Supplemental Dental Benefit
Medicare Questions?
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Content Last Updated: November 25, 2020