Wisconsin SeniorCare Fact Sheet
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Frequently Asked Questions
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. The Department of Health Services (DHS) administers the SeniorCare program. The following are frequently asked questions about the SeniorCare program. If your question has not been answered in this fact sheet, contact the SeniorCare Customer Service Hotline.
SeniorCare Customer Service Hotline
TTY and translation services available.
- How can I get a SeniorCare application?
- Who can help me complete the application form?
- Can someone apply for me?
- I do not have a Social Security Number. Can I receive SeniorCare benefits?
- My birthday is next month. When can I apply?
- What if I am receiving Social Security or Medicare, but I am not 65. When can I apply?
- Can I find out if I might be eligible before actually applying for SeniorCare?
- How long must I live in Wisconsin before I can apply?
For More Information:
- Call the SeniorCare Customer Service Hotline at (800) 657-2038, or
- Visit the SeniorCare Web site at: dhs.wi.gov/seniorcare/.
Information provided in this document is general. To find out more detailed information regarding SeniorCare, please contact the SeniorCare Customer Service Hotline at 1-800-657-2038.
DHS 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 the SeniorCare Customer Service Hotline at 1-800-657-2038. All translation services are free of charge.
For civil rights questions call (608) 266-9372 or 1-888-701-1251 TTY.
GENERAL INCOME QUESTIONS
GROSS SOCIAL SECURITY INCOME
INTEREST AND DIVIDENDS
INCOME THAT IS NOT COUNTED
Immigrants with particular legal immigration status may qualify for SeniorCare. You are encouraged to apply and SeniorCare will determine your eligibility. After you send in your application form, you will receive a letter requesting that you send a copy of both sides of your immigration registration card. You will also need to identify your country of origin. Do not send copies of your immigrant registration card until it is requested.
An annual enrollment fee of $30 per individual or $60 per couple is required for participation in the SeniorCare program.
Enrollment fees can be paid by personal check, cashier?s check or money order. Make your check or money order payable to: State of Wisconsin. Write the SSN?s of all applicants on your check or money order. Do not send cash.
You can make one payment for both applicants. Make your check or money order out for $60 and write the SSN of both applicants on the check or money order.
You are encouraged to use all capital letters when completing the form. If you have used lower case, SeniorCare may still be able to process your application. If SeniorCare is unable to process your application, you will be contacted by a SeniorCare representative.
If you make a mistake on the application form, you can correct it with correction fluid such as Wite-Out or liquid paper.
Only one signature is required. Either applicant can sign the application form.
A space should be left between each word.
Spouses who live together must report income information for both individuals even if one spouse does not meet the age requirement or meets the requirement but chooses not to participate in the SeniorCare program.
Income information for SeniorCare is based on your good faith estimate of what your income will be for the next year. You can use last year's income as a guide to estimate your income for the next 12 months.
Contact the SeniorCare Customer Service Hotline at 1-800-657-2038 and a customer service representative will help you.
If your Medicare Part B premium is deducted by the Social Security Administration from your Social Security payment, you need to add the amount of your Part B premium payment to the amount of your Social Security payment and include the annual total on the SeniorCare application form. If you do not know the Medicare premium amount that is deducted from your payment, contact the Social Security Administration at 1-800-772-1213.
Report this as your income under the applicant column on the SeniorCare application form.
Wages and salaries received as part of a training program must be counted as income for SeniorCare. This is true even if the training program is funded under the Older Americans Act of 1965.
Even though these payments are turned over to the church they are considered income and must be reported to the SeniorCare program.
Any payments received for providing care to another individual, even if it is a family member, is counted as income and must be reported to the SeniorCare program.
In most cases, interest and dividends are counted as income even if the payments are rolled back into your asset and you do not receive them directly. There is one exception; you do not have to count irrevocable interest you receive on irrevocable burial trusts.
Interest and dividends on these accounts are counted as income and must be reported to the SeniorCare program.
Include your share of the interest on the account. Each person who is a holder in the account is assigned an equal share.
Example: Your savings account earns $50 each year. In this case, since there are two people on the account, you would report $25 as income.
If you and your spouse live together and own a joint account, you should show half of the interest amount in the "Applicant" column on the SeniorCare application form, and the other half in the "Spouse" column. If you are filing separate applications because you do not live together, include only your share on your individual application.
Any portion of the monthly payment that is considered interest must be counted as income. You do not have to count the principal as income.
Report any capital gains that are reportable as capital gains to the IRS for tax purposes and that you expect to have in the next 12 months. If you are not sure your capital gains are reportable to the IRS for tax purposes, check with your tax advisor, a tax attorney or other tax expert.
If you add up all of your capital gains, and you anticipate a loss overall, your capital gain amount is considered $0 for SeniorCare. Do not report negative amounts on the SeniorCare application form. Report your capital gains under "Interest and Dividends" on the SeniorCare application form.
If you add up all of your income from your self-employment and you anticipate an overall loss, your self-employment amount is considered $0 for SeniorCare. Do not report negative amounts on the SeniorCare application form.
The retirement income category includes some income sources that you might not specifically call a pension. You should report income from all of your retirement accounts. A retirement account is an annuity or work-related plan that provides income when employment ends. Examples include a pension, a disability plan or other retirement plan that is administered by an employer or union. Other examples are funds held in an individual retirement account (IRA) and plans for self-employed individuals, sometimes referred to as Keogh plans. A 401K plan would also be considered a retirement account.
You must count payments, withdrawals and distributions you expect to receive from your retirement account in the next 12 months, with one exception. If you have not previously made any withdrawals from a retirement account, and you withdraw the full amount at one time, you do not have to count it as income.
The portion of a veteran?s disability payment that is for unusual medical expenses, aid and attendance, or a housebound allowance does not count as income. Otherwise, your veteran?s disability payment should be reported as income. You should check with the Veteran?s Administration at 1-800-827-1000 to determine if any portion of your payment is considered an allowance for unusual medical expenses, aid and attendance, or a housebound allowance. If it is, deduct that portion from your total annual veteran?s disability payment. Include the remainder on your SeniorCare application under "Other Income".
You should also know that a reimbursement from the Veterans Administration for medical costs does not count as income.
Payments received from a federal farm subsidy are considered income and should be reported as income to the SeniorCare program.
In all cases, subtract your annual operating expenses from the annual amount of your gross rental income. Operating expenses include ordinary and necessary expenses such as insurance, utilities, taxes, advertising for tenants and repairs. Repairs include such expenses as repainting, fixing gutters or floors, plastering and replacing broken windows.
If your rental income could be reported to the IRS as self-employment income and you are subject to the federal self-employment tax for your rental income (usually this only applies if you are a real estate dealer who is buying and selling land, or a farmer who reports income as self-employment income), you may also deduct depreciation from your gross rental income. The IRS publication 533 may be helpful in providing you with information about rental income that is subject to the federal self-employment tax. Include your net rental income amount under "Other Income" on the SeniorCare application form.
You are considered the "community spouse." Income allocated to you from your spouse who is a Medicaid recipient and is residing in a nursing home should be considered income on your SeniorCare application. Report only the amount that is actually allocated.
|For example, if the notice that you received from the Medicaid program says that your spouse can allocate up to $1,000 to you, but the available income is only $650 and $45 of that is set aside as the personal allowance, count only $605 per month ($650 less $45). In this example, the $605 would be multiplied by 12 months and the total annual amount of $7,260 would be counted as income for the SeniorCare program.|
Savings and checking accounts are considered assets. Withdrawals from your savings and/or checking account are considered a conversion of an asset and are not counted as income. However, you must count the interest you receive from your savings and/or checking accounts as income.
Your CD and money market accounts are considered assets and are not counted as income. However, you must count the interest that you receive on these as income.
If you are found eligible, the benefit period is 12 months.
You will receive a Preprinted Renewal Application and instructions approximately 6 weeks prior to the end of your current benefit period.
For example, if your current benefit period ends August 31st, your Renewal Application will be mailed in mid-July.
SeniorCare will provide prescription drug coverage for most medically necessary drugs, when the drug manufacturer has signed a SeniorCare rebate agreement. There are some limitations. You will be asked to use the generic form of the drug. Some brand names will be allowed if properly authorized by your healthcare provider.
For information regarding the SeniorCare rebate agreement, see the SeniorCare Covered Drugs fact sheet at dhs.wis.gov/seniorcare/factsheets/p10084.htm.
There are currently 1,200 pharmacies that are participating in the SeniorCare program. Contact your local pharmacy to see if they currently participate. If your pharmacy is not a SeniorCare participating pharmacy, contact the SeniorCare Customer Service Hotline at 1-800-657-2038, and they will be able to help you find a pharmacy in your area.
Because of the number of drugs that SeniorCare covers, the list is extensive. If you have questions regarding a specific drug, you can ask your pharmacy or contact the SeniorCare Customer Service Hotline at 1-800-657-2038.
Pharmacies must charge you the same price as they would charge people that are not in SeniorCare. If your pharmacy is charging you more for your prescriptions now that you are in SeniorCare, you should contact the pharmacy and ask why you are paying more. If after contacting your pharmacy, you feel that you are being charged an incorrect amount, contact the SeniorCare Customer Service Hotline at 1-800-657-2038.
Over the counter drugs are not covered, even if prescribed by a healthcare provider, with the exception of insulin.
Depending on your level of participation, you could have a spenddown and/or deductible. For more information about spenddown and deductible, see the SeniorCare Spenddown and Deductible fact sheet.
NOTE: Only SeniorCare covered drugs can be used to meet the spenddown or deductible.
The co-payment amounts are $5 for each covered generic drug, and $15 for each covered brand name drug. If you have a spenddown or deductible, you will be required to pay a co-payment after the spenddown or deductible are met.
The spenddown and deductible cannot be prepaid. However, as your pharmacy bills SeniorCare for each covered drug, SeniorCare automatically tracks your expenses.
Prescription costs used meet the spenddown and/or deductible in the 12-month benefit period do not carry over to the next benefit period. If you become eligible for another 12-month benefit period, you will have to start a new spenddown and/or deductible.
If your pharmacy shows you have a spenddown and you disagree, contact the SeniorCare Customer Service Hotline at 1-800-657-2038. They will research the discrepancy for you.
If you do not have other prescription drug coverage, contact the SeniorCare Customer Service Hotline at 1-800-657-2038. If you had other prescription drug coverage that has been cancelled, make sure that you have the termination date of the other coverage before calling the SeniorCare Customer Service Hotline. They will need this date to update your SeniorCare coverage.
If you have prescription drug coverage under other health insurance plans including Medicare Parts A and B, you may enroll in SeniorCare. SeniorCare will coordinate benefit coverage with all other insurance coverage including Medicare covered drugs. SeniorCare will also coordinate benefits with pharmacies that accept discount cards. Contact the SeniorCare Customer Service Hotline at 1-800-657-2038 and they will help you.
A notice of decision will be mailed that tells you if you have been approved for SeniorCare benefits. If approved, your notice of decision will tell you in what benefit level you are enrolled. If you have been approved, you will receive a SeniorCare identification card shortly after receiving your notice of decision. You will also receive a SeniorCare Participant Handbook that explains your SeniorCare benefits in more detail.