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Wi f seniorcare application form 2025

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The document provides detailed application instructions for the SeniorCare Prescription Drug Program in Wisconsin. It outlines eligibility requirements, the application process, necessary fees, and information needed from applicants regarding their income and personal details. The document emphasizes the importance of completing the application accurately and submitting it with the required enrollment fee to avoid delays in processing. Additionally, it offers resources for assistance and outlines applicants' rights and responsibilities.

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Click ‘Get Form’ to open the wi f seniorcare application form in the editor.
Begin by filling out the Applicant and Spouse Information sections. Ensure you provide accurate details for both you and your spouse if applicable, as this will determine your eligibility.
In the Mailing Address section, clearly indicate where you would like correspondence sent. Shade in the appropriate circle to specify if this is your residence or a representative's address.
Proceed to the Expected Annual Income section. Enter anticipated gross income amounts for the next 12 months, ensuring all figures are rounded to the nearest dollar.
Complete Section V by signing the application. Remember, forms without a signature cannot be processed.
Finally, enclose your enrollment fee and double-check that all sections are complete before submitting your application.

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2018	4.8 Satisfied (185 Votes)
2011	4.3 Satisfied (95 Votes)

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How do I apply for SeniorCare in Wisconsin?

To apply for SeniorCare, request an application from the SeniorCare Customer Service hotline at 800-657-2038 or print one at .dhs.wisconsin.gov/seniorcare. On the application, you will need to provide your Social Security number. You will also have to pay a $30 annual enrollment fee per person.

What drugs are covered under senior care in Wisconsin?

The program covers most medically necessary drugs as long as the drug manufacturer has signed a rebate agreement with SeniorCare. There are exceptions, though. You may be asked to use the generic form of a drug or to get a prior authorization for certain medicines.

What is the income limit for SeniorCare in Wisconsin?

Financial Requirements LevelIndividual Income LimitCouple Income Limit Level 1 Up to $24,096 Up to $32,704 Level 2A $24,097$30,120 $32,705$40,880 Level 2B $30,121$36,144 $40,881$49,056 Level 3 $36,145 or greater $49,057 or greater

What is Wi SeniorCare?

SeniorCare is a prescription drug assistance program for Wisconsin residents who are 65 years of age or older who meet enrollment criteria. SeniorCare is administered by the Wisconsin DHS (Department of Health Services) . Within DHS, DMS (Division of Medicaid Services) is directly responsible for managing SeniorCare.