Information About SeniorCare

1 Information About SeniorCare What is SeniorCare ? What prescriptions are covered by SeniorCare is a prescription drug assistance program SeniorCare ? for Wisconsin residents who are 65 years of age or SeniorCare covers most generic and brand name older and meet the enrollment requirements. The prescription drugs and over-the-counter insulin;. program is designed to help seniors with their coverage may vary based on the level of benefits you prescription drug costs. have. Reimbursement for most drugs is limited to a 34-day supply. Some maintenance drugs may be Who can enroll in SeniorCare ? provided in a three-month supply. To enroll in SeniorCare you must be: A Wisconsin resident. What if I have other prescription drug A citizen or have qualifying immigrant status.

2 Coverage? 65 years of age or older. If you already have prescription drug coverage under another health insurance plan, you are still eligible to How can I apply for SeniorCare ? enroll in SeniorCare . SeniorCare will coordinate To apply for SeniorCare , request an application from benefit coverage with your existing plan. People the SeniorCare Customer Service hotline at enrolled in Medicaid are not eligible for SeniorCare . 800-657-2038 or print one at On the What is a copay? application, you will need to provide your Social A copay is the amount you pay out of pocket each Security number. You will also have to pay a $30 time you get a covered drug from your pharmacy. annual enrollment fee per person. What is a deductible? When can I apply? A deductible is the amount that members in Levels The earliest you can apply is during the calendar 2a, 2b, and 3 pay annually for covered drugs at the month of your 65th birthday.

3 If you are already age SeniorCare rate before SeniorCare copays begin. 65 or older, you can apply at any time. Your benefits Only covered drugs purchased at the SeniorCare rate will begin in the month after you apply. will be used to meet the deductible. How much will SeniorCare cover? What is a SeniorCare rate? Your annual income determines your level of The SeniorCare rate is a discounted rate for most coverage in SeniorCare and how much SeniorCare covered drugs. Members who are still paying toward will cover. See the table on the following page for their deductible will pay the SeniorCare rate on out-of-pocket expenses and benefits for each level of covered drugs. participation. Wisconsin Department of Health Services What is a spenddown? Only SeniorCare -covered drugs purchased at the A spenddown is the total amount you have to pay pharmacies' retail price will be used to meet your for covered drugs before you move to the spenddown.

4 Covered drug costs for the spenddown deductible phase of your enrollment. If you are a will be tracked automatically by the SeniorCare SeniorCare member with Level 3 coverage, you are program. During the spenddown, there is no required to meet an annual spenddown. The discount on drug costs. spenddown amount is shared for a married couple Where can I get more Information ? when both are eligible for SeniorCare . Your Call the SeniorCare Customer Service hotline at spenddown is the difference between your gross 800-657-2038 (voice) or 711 (TTY). annual income and 240% of the current federal Visit the SeniorCare website, poverty level (FPL). SeniorCare 2021 Annual Income Limits and Out-of-Pocket Expenses by Level of Participation Income Limits Out-of-Pocket Expenses Income at or below No deductible or spenddown.

5 Level 1. 160% of the FPL $5 copay for each covered generic prescription drug. Individual: $20,608 $15 copay for each covered brand name prescription drug. Couple: $27,872. Income Limits Out-of-Pocket Expenses Income between 160% and $500 deductible per person. Level 2A. 200% of the FPL Pay the SeniorCare rate for covered drugs until the $500 deductible is met. Individual: $20,609 to $25,760 After $500 deductible is met, pay a $5 copay for each covered generic Couple: $27,873 to $34,840 prescription drug and a $15 copay for each covered brand name prescription drug. Income Limits Out-of-Pocket Expenses Income between 200% and $850 deductible per person. Level 2B. 240% of the FPL Pay the SeniorCare rate for covered drugs until the $850 deductible is met. Individual: $25,761 to $30,912 After $850 deductible is met, pay a $5 copay for each covered generic Couple: $34,841 to $41,808 prescription drug and a $15 copay for each covered brand name prescription drug.

6 Income Limits Out-of-Pocket Expenses Income more than Pay retail price for covered drugs during spenddown. 240% of the FPL After the spenddown is met, meet an $850 deductible per person. Level 3. Individual: $30,913 or greater Pay the SeniorCare rate for covered drugs until the $850 deductible is met. Couple: $41,809 or greater After $850 deductible is met, pay a $5 copay for each covered generic prescription drug and a $15 copay for each covered brand name prescription drug. Nondiscrimination Statement The Department of Health Services is an equal opportunity employer and service provider. If you have a disability and need to access this Information in an alternate format, or need it translated to another language, please contact SeniorCare Customer Service at 800-657-2038 (voice) or 711 (TTY).

7 All translation services are free of charge. For civil rights questions call 608-266-9372 or 888-701-1251 TTY. Division of Medicaid Services P-10078 (02/2021).