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Eligibility Management (Income Maintenance) Home >> Customer Help >> SeniorCare Help >>

Customer Help - SeniorCare

To see if you may be able to get SeniorCare or to check your benefits, go to  At this time, you cannot apply for SeniorCare on ACCESS.


Application F-10076 (PDF, 152KB) To apply for SeniorCare Prescription Drug Assistance

Authorization of Representative F-10080 (PDF, 32KB) Designate someone to apply for SeniorCare for you.

Fair Hearing Request (exit DHS) - To request a hearing if you don't agree with a decision about your benefits.

Fair Hearing Voluntary Withdrawal DHA 17, (PDF 10KB) *(exit DHS) If you want to withdraw your request for a hearing.


SeniorCare Member Handbook P-10079 To learn more about your SeniorCare Prescription Drug benefits.

ACCESS/Marketplace Takeaway Card, P-00555 - (English, Spanish) (PDF, 549KB)

Additional Links

Additional Information about SeniorCare can be found at

Agency Directory - To find the telephone number and address of your local agency.

Income Limits - To find current income limits.

Legal Services - To find the name and telephone number of who in your area can provide you with legal help.  You may also go to:

Disability Rights of Wisconsin Disability Rights Wisconsin is a private non profit organization which helps people across Wisconsin gain access to services and opportunity through its advocacy and legal expertise.*(exit DHS)

Last Revised: September 15, 2014