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Get the free 2025 Medicare HMO TotalDual Change of Plan Form

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Blue Shield of California Medicare Advantage Change of Plan Form Current Blue Shield of California Medicare Advantage Plan members may use this short enrollment form to enroll into a Medicare Advantage
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Medicare HMO TotalDual change refers to the process of updating or transitioning an individual's Medicare coverage from a standard HMO plan to a TotalDual eligible plan, which usually combines Medicare and Medicaid services.
Individuals who qualify for both Medicare and Medicaid and wish to change their Medicare HMO plan to a TotalDual plan are required to file a Medicare HMO TotalDual change.
To fill out the Medicare HMO TotalDual change form, individuals should obtain the appropriate form from the Medicare or Medicaid website, provide necessary personal and insurance information, and submit it by the designated method.
The purpose of the Medicare HMO TotalDual change is to allow eligible individuals to receive more comprehensive healthcare coverage that coordinates both Medicare and Medicaid benefits.
Information that must be reported includes personal identification details, current insurance policy information, any existing health conditions, and consent declarations for sharing information between Medicare and Medicaid.
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