Prescription Assistance


Wisconsin Seniorcare
Any Wisconsin Senior may be eligible for SeniorCare if you are a permanent resident of Wisconsin, and age 65 or older. There are three levels of program participation, which are dependent on your income. Only your gross income and/or gross social security is considered. Your assets - home, car and other things you own - are not counted.

If your prescription drugs are covered under another health insurance plan, you can still be enrolled in SeniorCare. SeniorCare will coordinate coverage with your other plan.

You will pay $5.00 per prescription for covered generic drugs and $15.00 per prescription for covered brand name drugs. Over the counter drugs, such as vitamins and aspirin are not covered, even if prescribed.

There is an enrollment fee of $30.00 and it takes approximately 3-4 weeks for your paperwork to be processed. You will then receive a SeniorCare card to be used each time you need to fill a prescription.

The following is a schedule of income levels:

LEVEL ONE:
Maximum for individual - $18,832
Maximum per couple - $25,488

LEVEL TWO A:
Per individual - $18,833 - $23,540
Per couple - $25,489 - $31,860
(With a $500 DEDUCTIBLE)

LEVEL TWO B:
Per individual - $23,541 - $28,248
Per couple - $31,861 - $38,232
(With an $850 DEDUCTIBLE)

LEVEL THREE:
Per individual - $28,249 or higher
Per couple - $38,233 or higher
(With an $850 DEDUCTIBLE plus a SPEND-DOWN)

Please use the link to the Wisconsin SeniorCare website for quick access to more information and instructions on how to apply or call the SeniorCare Customer Service at 1-800-657-2038.
SeniorCare and has also been deemed "creditable coverage" (equivalent or better) with regards to Medicare Part D, so the penalty associated with Medicare Part D will not accumulate while enrolled in SeniorCare. The SeniorCare program has been extended through 2016.


Medicare Part D Prescription Drug Benefit
Beginning January 1, 2006, people with Medicare had the option to enroll in a plan that covers prescription drugs. This new benefit is known as "Part D."

Who Is Eligible?
Anyone with Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance) can join a Medicare prescription drug plan. A person must live in the service area of a prescription drug plan to enroll.

When Can I Join?
If you currently have Medicare Part A and/or Part B, you can join a Medicare prescription drug plan between October 15 and December 7. Your Medicare prescription drug plan coverage will begin on January 1. Part D is a voluntary benefit. This means that an individual who receives Medicare benefits may choose to decline Part D coverage. However, if you delayed joining a Medicare prescription drug plan after you were first eligible, you are likely to pay a penalty in the form of a higher monthly premium. You will have to pay this higher premium as long as you have a Medicare prescription drug plan. The penalty will not apply if you currently have a drug plan that covers at least as much as a Medicare prescription drug plan.

Who Will Provide Medicare Beneficiaries With Drug Coverage?
Insurance providers and other private companies will offer Medicare Part D plans approved by the federal government.

What Drugs Will Be Covered By Medicare?
All plans must include coverage of certain drugs commonly prescribed to elderly and disabled people. Each Medicare prescription drug plan will develop a list of brand name and generic drugs it will cover, called a formulary. The government has not established a uniform list of drugs that every plan must cover. Therefore, consumers will have to compare the formularies offered by each plan available in their region, and enroll directly with the plan of their choice.

How Much Does It Cost?
Costs under Part D will vary according to a Medicare beneficiary's plan choice, medication needs, and income level. Many Medicare beneficiaries will have to pay a monthly premium for Part D coverage as well as a yearly deductible (up to $360 for 2016) and other out-of-pocket costs. Each drug plan can create its own cost structure - within a certain framework created by the federal government. Some plans may offer more coverage and additonal drugs for a higher monthly premium. Medicare beneficiaries with lower incomes and few assets, as well as Medicare beneficiaries who also have Medicaid coverage, will receive assistance with out-of-pocket costs associated with Part D.

What Happens If I Have Other Prescription Drug Coverage?
Many Medicare beneficiaries already have prescription drug coverage through another source such as an employer, union, Wisconsin SeniorCare, Medicaid and Medicare supplemental (Medigap) insurance. If you have been notified that your coverage is creditable, you can continue with your coverage without accruing any penalty with Part D. Medicare beneficiaries who currently receive prescription drug coverage under the Medicaid program will no longer have their drugs paid for by Medicaid after December 31, 2005. People with Medicare who also get full Medicaid benefits will need to enroll in a Part D plan of their choice or will be automatically enrolled in a Medicare prescription drug plan by the government. They will have the opportunity to switch to a different plan on a monthly basis if they need to.

Important Dates:
The Annual Enrollment Period is October 15 through December 7, with your coverage beginning on January 1. Late penalties of approximately 1% per month will apply if you delayed enrollment and did not have creditable drug coverage.

Help is Available!
If you have questions about Medicare Part D contact the Aging & Disability Resource Center at (262) 335-4497 or Toll Free (877) 306-3030. To find out more information about getting extra help (Low Income Subsidy or LIS) with your prescription drug costs, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit www.ssa.gov

Call 1-800-MEDICARE or visit www.medicare.gov

If you are under the age of 60 and receive Medicare, call the Disability Drug Benefit Helpline at 1-800-926-4862.