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What is SeniorCare?

SeniorCare is a prescription drug assistance program for Wisconsin residents who are 65 years of age or older who meet the eligibility criteria. The program is designed to help seniors with their prescription drug costs. Those interested may apply at any time. However, your application will not be accepted if you apply earlier than the calendar month before your 65th birthday.

To enroll in SeniorCare:

  • You must be a Wisconsin resident.
  • You must be a U.S. citizen or qualifying immigrant.
  • You must be 65 years of age or older.
  • You must pay a $30 annual enrollment fee per person.
  • Your assets, such as bank accounts, insurance policies, home property, etc., are not counted.
  • Your annual income determines the level of coverage (see SeniorCare Income Limits table below).

In addition, program participants are subject to certain annual out-of-pocket expense requirements depending on their annual income, as shown in the table below. Drug coverage may vary by Level. For more information about covered drugs, see the SeniorCare Covered Drugs fact sheet at dhs.wisconsin.gov/seniorcare/information.htm, call your pharmacy or the SeniorCare Customer Service Hotline.

Income Limits*

Annual Out-of-Pocket
Expense Requirements and Benefits

Level 1

  • No deductible or spenddown.

  • $5 copay for each covered generic prescription drug.

  • $15 copay for each covered brand name prescription drug.

Level 2a

  • $500 deductible per person.

  • Pay the SeniorCare rate for drugs until the $500 deductible is met.

  • After $500 deductible is met, pay a $5 copay for each covered generic prescription drug and a $15 copay for each covered brand name prescription drug.

Level 2b

  • $850 deductible per person.

  • Pay the SeniorCare rate for most covered drugs until the $850 deductible is met.

  • 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.

Level 3

  • Pay retail price for drugs equal to the difference between your income and $27,577 per individual or $37,225 per couple. This is called “spenddown.”

  • Covered drug costs for spenddown will be tracked automatically. During the spenddown, there is no discount on drug costs.

  • After spenddown is met, meet an $850 deductible per person.

  • Pay SeniorCare rate for most covered drugs until the $850 deductible is met.

  • After the $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.

*See the 2013 SeniorCare Income Limits table below. These amounts are based on federal poverty limit guidelines effective as of February 1, 2013. These amounts may increase by a small percentage each year.

Effective February 1, 2013

Group Size Level 1
Income at or below
160% FPL

Level 2a
Income between
160% - 200% FPL

Level 2b
Income between
200% - 240% FPL

Level 3
Income more than
240% FPL

Individual

$18,384

$18,385 — $22,980

$22,981 — $27,576

$27,577 or greater

Couple

$24,816

$24,817 — $31,020

$31,021 — $37,224

$37,225 or greater

What if members have other prescription drug coverage?

Individuals with prescription drug coverage under other health plans are eligible to enroll in SeniorCare. If you already have a health insurance plan, SeniorCare will coordinate benefit coverage with your plan. Individuals enrolled in Medicaid will not be enrolled in SeniorCare.

What is a Deductible?

A deductible is an amount that members in Levels 2a, 2b and 3 pay annually for covered drugs before being able to participate at the copayment levels. During the deductible period, members receive the SeniorCare rate on covered drugs that are purchased.

What is a “SeniorCare Rate”?

The “SeniorCare rate” is a discounted rate for most covered drugs. Members in the deductible period will pay the SeniorCare rate on covered drugs.

What is a Spenddown?

At Level 3, you have an annual spenddown requirement. The amount of the spenddown is the difference between your gross annual income and 240% of the current Federal Poverty Level.

After you have met the spenddown, during your benefit period, you will have an $850 deductible. You will receive the SeniorCare rate on covered prescription drugs during your deductible period.

What Expenses Can I Use to Meet a Deductible or a Spenddown?

Only SeniorCare covered drugs purchased at the retail price will be used to meet the member’s spenddown, and SeniorCare covered drugs purchased at the SeniorCare rate will be used to meet the deductible. Other medical costs, such as physician office visits or hospital services do not count toward the SeniorCare spenddown or deductible.

At Level 3, you have an annual spenddown requirement. The amount of the spenddown is the difference between your gross annual income and 240% of the current Federal Poverty Level.

After you have met the spenddown, during your benefit period, you will have an $850 deductible. You will receive the SeniorCare rate on covered prescription drugs during your deductible period.

What Expenses Can I Use to Meet a Deductible or a Spenddown?

Only SeniorCare covered drugs purchased at the retail price will be used to meet the member’s spenddown, and SeniorCare covered drugs purchased at the SeniorCare rate will be used to meet the deductible. Other medical costs, such as physician office visits or hospital services do not count toward the SeniorCare spenddown or deductible.

Individuals with prescription drug coverage under other health plans are able to enroll in SeniorCare. If you already have a health insurance plan, SeniorCare will coordinate benefit coverage with your plan. Individuals enrolled in Medicaid will not be eligible for SeniorCare, because Medicaid already provides prescription drug coverage.

For More Information:

  • Call the SeniorCare Customer Service Hotline at 1-800-657-2038 (voice) or 711 (TTY) or

  • Visit the SeniorCare Web site at: dhs.wi.gov/seniorcare.

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, contact SeniorCare Customer Service at 1-800-657-2038 (voice) or 711 (TTY). All translation services are free of charge. For civil rights questions call (608) 266-9372 or 1-888-701-1251 TTY.

P-10078 (02/13)

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Date Last Revised:  February 28, 2013