Dept of Health & Human Services (DHHS)

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What is SeniorCare?
SeniorCare is a prescription drug assistance program for Wisconsin residents who are 65 year of age or older who meet the eligibility criteria. The program, which began September 2002, is designed to help seniors with their prescription drug costs.

What are the eligibility requirements?

  • You must be a Wisconsin resident.

  • You must be 65 years of age or older.

  • You must pay a $30 annual enrollment fee per person.

  • Assets, such as bank accounts, insurance policies, home property, etc., are not counted

  • Your annual income determines the level of coverage

 In addition, program participants are subject to certain annual out-of-pocket expense requirements depending on their annual income.

Senior Care Income Guidelines

What if program participants have other prescription drug coverage?
Individuals with prescription drug coverage under other health plans are eligible to enroll in SeniorCare. SeniorCare will coordinate benefit coverage with those plans. However, individuals enrolled in Medicaid are not eligible for SeniorCare because Medicaid already provides prescription drug coverage.

What is a Deductible?
A deductible is an amount that participants in Levels 2a, 2b, and 3 pay annually for covered drugs before they are eligible to participate at the co-payment levels. During the process of meeting the deductible, a participant receives the SeniorCare rate when purchasing covered drugs.

What is a "SeniorCare Rate"?
A "SeniorCare Rate" is a discounted rate for most covered drugs. During the process of meeting the deductible, a participant receives the SeniorCare rate when purchasing covered drugs.

What is a Spenddown?
A spenddown is a dollar amount. It is the difference between your gross annual income and 240% of the current Federal Poverty Level. At Level 3 you have an annual spenddown requirement during your benefit period. 
After you have met the spenddown requirement you will also have an $850 deductible. However, while you are meeting this deductible you receive the SeniorCare rate when purchasing covered prescription drugs.

What Expenses Can I Use to Meet a Deductible or a Spenddown?
Only SeniorCare covered drugs purchased at the retail price can be used to meet a participant's spenddown.
Only SeniorCare covered drugs purchased at the SeniorCare rate can be used to meet a participant's deductible.
Medical costs such as physician office visits or hospital services do not count toward a participant's spenddown or deductible.

How do I apply?
Seniors may apply for SeniorCare themselves or receive assistance at workshops throughout Walworth County. Applications may be obtained at

  • Walworth County Department of Health & Human Services Center W4051 County Road NN
    Elkhorn
  • Mercy Walworth Medical Center
    Junction Highways 50 and 67
    Lake Geneva
  • Any Aurora Health Center

Applications may also be obtained by calling the SeniorCare Customer Service Hotline at (800) 657-2038 or at the SeniorCare website at www.dhfs.wisconsin.gov/seniorcare.  

If you are homebound and would like to arrange a home visit to enroll in SeniorCare please call (262) 728-4745.

Where can I receive more information about SeniorCare?
Call the SeniorCare Customer Hotline at (800) 657-2038.

 


 
 

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