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.

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 (PDF, 189KB) - 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: November 20, 2014