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For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed below for further information. NOTE: You may receive this notice at other times in the
future such as before the next period you can enroll in Medicare prescription drug coverage, and if this
coverage changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare &
You” handbook from Medicare. You’ll get a copy of the handbook in the mail every year from Medicare. You
may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage: Visit
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare
& You” handbook for their telephone number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for Medicare prescription drug coverage is
available. Information about this extra help is available from the Social Security Administration (SSA). For
information about this extra help, visit SSA online at r call them at 1-800-772-1213
(TTY 1-800-325-0778).
Date: 05/01/2017
Blue Cross and Blue Shield of Kansas City
Medicare Support Unit
2301 Main, Kansas City, MO 64141-6169
1-800-784-9654
CMS Form 10182-CC
Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this
information collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data
resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of
the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance
Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may
be required to provide a copy of this notice when you join to show whether or not you have maintained
creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).