Wisconsin SeniorCare Renewal Instructions and Benefits
This document provides essential details on renewing your SeniorCare benefits in Wisconsin for residents aged 65 or older. It outlines the steps for filling out the renewal application and offers answers to commonly asked questions. Ensure you follow the guidelines to maintain your prescription drug coverage.
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How do I fill this out?
To fill out your SeniorCare renewal application, begin by reviewing the preprinted information. Make any necessary corrections and complete the change section if applicable. Finally, ensure you include the required enrollment fee to avoid delays in processing.

How to fill out the Wisconsin SeniorCare Renewal Instructions and Benefits?
1
Review the preprinted renewal application carefully.
2
Make necessary corrections or updates in the 'change' section.
3
Sign the application if completed by an authorized representative.
4
Include the $30 enrollment fee per person.
5
Mail the completed application and fee to the provided address.
Who needs the Wisconsin SeniorCare Renewal Instructions and Benefits?
1
Seniors 65 years and older who reside in Wisconsin and need prescription coverage.
2
Caregivers of seniors who want to assist with the renewal process.
3
Individuals who recently experienced a change in marital status.
4
Those who need to report a change in residency or living arrangements.
5
Seniors who have inquiries regarding their current benefits or coverage.
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What are the instructions for submitting this form?
To submit your renewal application, send it along with the $30 enrollment fee to SeniorCare at PO Box 6710, Madison, WI 53716-0710. You can also submit your documents via fax at 608-267-0900 or reach out to SeniorCare Customer Service if you require assistance. Always double-check that all sections are completed before mailing your application to prevent processing delays.
What are the important dates for this form in 2024 and 2025?
For 2024, ensure your renewal application is submitted by the due date indicated in your notice. In 2025, maintain awareness of your renewal period by consulting the custom notification you receive. Remember to keep an eye out for any changes or updates regarding enrollment fees or requirements.

What is the purpose of this form?
The purpose of this form is to facilitate the renewal of SeniorCare benefits for eligible Wisconsin residents aged 65 and older. It ensures that seniors can continue to receive the necessary assistance for prescription drugs and vaccines. By filling out this form, recipients can maintain their healthcare coverage without interruption.

Tell me about this form and its components and fields line-by-line.

- 1. Applicant Information: Includes details such as name, address, and Social Security number.
- 2. Income Calculation: Tracks income levels to determine eligibility for benefits.
- 3. Enrollment Fee Payment: Confirms that the requisite fee is included with the application.
- 4. Authorized Representative: Allows applicants to designate someone to handle their application.
- 5. Signature Section: Where the applicant or their representative signs to certify the information is accurate.
What happens if I fail to submit this form?
Failing to submit your renewal form can lead to a gap in your prescription drug coverage. It is crucial to ensure that all required information is provided to avoid delays. If your application is returned, you will need to resolve any deficiencies promptly.
- Coverage Gap: Your access to necessary prescription drugs may be interrupted.
- Delayed Processing: Incomplete forms will slow down the renewal process.
- Potential Reapplication: You may have to start the process from scratch if your application is not submitted appropriately.
How do I know when to use this form?

- 1. Annual Renewal: For renewing your benefits every 12 months.
- 2. Change in Personal Information: To update any relevant personal details such as income or marital status.
- 3. Change in Residency: If you move to a different address in Wisconsin.
Frequently Asked Questions
How do I know if my renewal was successful?
SeniorCare will inform you in writing within four to six weeks of receiving your application.
What if my application is incomplete?
Incomplete applications will be returned to you for correction before processing.
Who can I contact for help?
For any renewal questions, call SeniorCare Customer Service at 800-657-2038.
Do I need to pay an enrollment fee?
Yes, a $30 enrollment fee per person is required with your renewal.
What should I do if my circumstances change?
Report any significant changes by completing the 'change' section on your application.
How can I access this information in another format?
Call SeniorCare Customer Service for assistance with accessing information in different formats.
What if I want to authorize someone else to help with my application?
Include the authorized representative's information in the application process.
When should I return my renewal application?
As soon as possible to avoid any gaps in coverage.
What happens if I forget to apply for renewal?
You could experience a delay or gap in your prescription drug coverage.
Are there resources available for help with filling this out?
Yes, you will receive an income calculation worksheet and instructions with your renewal application.
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