Wisconsin SeniorCare Program: Eligibility, Levels and How to Apply

What SeniorCare Is

SeniorCare is Wisconsin's own prescription drug assistance program for residents 65 and older. It operates under a federal Section 1115 demonstration waiver (authorized through December 31, 2029) and runs completely separately from the Medicare Savings Programs and from Medicaid. It has its own application, its own eligibility rules, and its own renewal cycle.

The core benefit: SeniorCare caps prescription copays at $5 for generics and $15 for brand-name drugs, after any applicable deductible. The annual enrollment fee is $30 per person.

Who Qualifies

The requirements are straightforward:

• Age 65 or older
• Wisconsin resident
• U.S. citizen or qualifying legal immigrant
• Pay the $30 annual application fee

SeniorCare has no asset test. You could have $500,000 in savings and still qualify. Only income determines your participation level.

2026 Income Levels

SeniorCare uses gross annual household income measured against the Federal Poverty Level:

Level 1 members pay the $30 fee and start getting $5/$15 copays immediately — no deductible. Levels 2a and 2b pay their deductible out of pocket first, then shift to the $5/$15 copay rate. Level 3 involves a spenddown (explained below).

How Level 3 Spenddown Works

If your income exceeds 240% FPL, you're in Level 3. The spenddown is the dollar amount by which your annual income exceeds that threshold.

Example: A single senior earning $39,360 annually exceeds the Level 3 floor ($36,360) by $3,000. That $3,000 is the spenddown. The senior pays full retail prices for prescriptions until out-of-pocket costs reach $3,000. Then there's an $850 deductible phase at SeniorCare's discounted contract rate. After the deductible is met, the $5/$15 copays kick in for the rest of the benefit year.

How to Apply

SeniorCare applications are completely separate from MSP applications. You do not apply through the ACCESS portal. Instead:

1. Apply using Form F-10076 by mail or through a dedicated SeniorCare online portal
2. Include the $30 annual fee (per person)
3. For paper applications, mail to: SeniorCare, 1 West Wilson Street, Madison, WI 53703

Customer Service: 1-800-657-2038

The benefit period runs 12 months from your enrollment date, and you'll need to renew annually with a new $30 fee.

SeniorCare as Creditable Coverage

SeniorCare Levels 1 and 2 count as creditable coverage for Medicare Part D. That means a senior enrolled in SeniorCare at Level 1 or 2 does not need a standalone Part D plan and will not incur a late enrollment penalty for going without Part D coverage.

SeniorCare Is Not Connected to Medicaid MSP

A common source of confusion: enrolling in a Medicare Savings Program (QMB, SLMB, SLMB+) does not automatically enroll you in SeniorCare, and vice versa. The two programs run through entirely different state systems. MSP goes through your county's Income Maintenance consortium via the ACCESS portal. SeniorCare goes through a separate application mailed to Madison.

If your parent qualifies for both, they need to file two applications. The good news is that SeniorCare has no asset test, so the financial hurdle is only about income — and the income limits for SeniorCare Level 1 ($24,240/year single) are substantially higher than any MSP tier.

For more on how SeniorCare interacts with Part D and Extra Help, see our post on SeniorCare vs Part D. Our Wisconsin Medicare Savings guide covers SeniorCare coordination in detail, including the spenddown math and when dual enrollment actually saves money.

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