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Wisconsin SeniorCare

Published by Mike Lovell on

SeniorCare

SeniorCare is a prescription drug assistance program for Wisconsin residents who are 65 years of age or older and meet the enrollment requirements.  The program is designed to help seniors with their prescription drug costs.

To enroll in SeniorCare you must be:

  • A Wisconsin resident
  • A U.S. Citizen or have qualifying immigrant status
  • 65 years of age or older

SeniorCare Program Structure

A $30 enrollment fee gets you into SeniorCare for 12 months.  As long as you are 65 or older, your SeniorCare coverage can start the 1st of the following month.

Anyone that meets that minimum requirements can enroll in SeniorCare.  But the program works differently based off your income.

The lower your income, the quicker you get into the benefit levels of SeniorCare.

1 – Individual income below $19,984 or couples below $27,056 per year

If you are earning income at this level, you are eligible for SeniorCare benefits after paying a $30 per person enrollment fee.  For covered medications, your coverage is:

  • Deductible $0
  • Generic copay $5
  • Brand copay $15

2A – Individual income between $19,985 and $24,980 or couples between $27,056 and $33,820 per year

If you are earning income at this level, you are eligible for SeniorCare benefits after paying a $30 per person enrollment fee.  For covered medications, your coverage is:

  • Deductible $500 per person
  • Generic copay $5
  • Brand copay $15

2B – Individual income between $24,981 and $29,976 or couples between $33,821 and $40,584 per year

If you are earning income at this level, you are eligible for SeniorCare benefits after paying a $30 per person enrollment fee.  For covered medications, your coverage is:

  • Deductible $850 per person
  • Generic copay $5
  • Brand copay $15

3 – Individual income above $29,976 or couples above $40,584 per year

If you are earning income at this level, you are eligible SeniorCare benefits after paying a $30 per person enrollment fee.  People earning this level have to meet a spenddown before SeniorCare coverage kicks in.

That means you need to spend down your income until you meet the level above (2B).  This can be confusing so here is an example to try to help make it clear.

You are a couple earning $50,000 per year and you enroll in SeniorCare.  That means you will pay the full retail cost of medications until you spend down your income below $40,584.  That means you would pay retail cost of medications until you have spent $9,416 in medication costs.  Then you would still need to meet your $850 per person deductible before your full SeniorCare coverage would kick in.

For covered medications, your coverage is:

  • Spenddown
  • Deductible $850 per person
  • Generic copay $5
  • Brand copay $15

How many people areon SeniorCare?

SeniorCare only covers Wisconsin residents.  The last update showed more than 93,000 people on SeniorCare.  This includes roughly 50,000 people who qualify for one of the first two levels of SeniorCare coverage which are level 1 and 2A.

Wisconsin has more than 1.1 million people on Medicare.  Not all of these people are age 65 so some of them many not be eligible for SeniorCare.  But you can see that SeniorCare is beneficial to many people here.

But many people choose other options for their prescription drug coverage.

What if you have other prescription medication coverage?

If you already have prescription drug coverage under another health insurance plan, you are still eligible to enroll in SeniorCare.  People enrolled in Medicaid are not eligible for SeniorCare.  SeniorCare will coordinate benefit coverage with your other insurance, including Medicare Part B or D.  If you enroll in SeniorCare, you will not be automatically disenrolled from your Medicare Part D plan.

That means it’s possible to have a stand-alone part D plan and SeniorCare.  You could also potentially have Medicare Advantage that includes part D coverage plus SeniorCare.

SeniorCare is considered creditable coverage.  That means if you decide to enroll in SeniorCare, you do NOT need to enroll in a Medicare Part D plan.  But just because you do not NEED to doesn’t mean that you shouldn’t.

The extra risk you are taking if your income is in level 3 may not be worth the savings compared with purchasing a Medicare Part D plan. The national average for Part D plans is around $35 per month.  Since that is the average there are obviously plans priced below that amount.

That means if you were the couple in the example above earning $50,000 per year then you could be risking almost $10,000 to potentially save around $150 per year in premiums.

Quantity Limits

Most medications covered under SeniorCare are limited to a 34 day supply.  There are a few classes of medications that can be filled in a three month supply.  But that is important to know beforehand if you prefer to have your medications filled in 90 day supply levels.

Where to Apply

SeniorCare has a 2 page, paper application that you can find on their website here.

There are many different options on how to cover prescription medication if you are on Medicare.  I know it can be confusing.  So if you would like help narrowing it down and finding a plan you are comfortable with, please call me at 608-571-4461.

We can review your options together and you can decide which one you prefer most.

Mike Lovell
Mike@askMedicareMike.com