Customer Help - SeniorCare

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

Forms

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.

Publications

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

Additional Links

Additional Information about SeniorCare can be found at dhs.wisconsin.gov/seniorcare.

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