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For more information or help with enrollment,

please call 1-800-678-2265 (TTY: 711),

February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET,
Monday through Friday.

October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET,

seven days a week.

or visit www.bluecrossma.com/medicare.

Blue Cross Blue Shield of Massachusetts is an HMO and PPO Plan with an Medicare contract.
Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.
Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance
may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The
Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice
when necessary.

®, SM Registered and Service Marks of the Blue Cross and Blue Shield Association. © 2016 Blue Cross and
Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
163138M-3 55-0604-17V2 (11/16)

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