Page 433

• Service Corps of Retired Executives (see SECTION 15.3.22 SPECIAL PROGRAMS) • University Year for Action Program (see SECTION 15.3.22 SPECIAL PROGRAMS) • Volunteers in Service to America (see SECTION 15.3.22 SPECIAL PROGRAMS) • W-2 payments for transitional jobs and community service jobs (see SECTION 15.3.28 WISCONSIN WORKS PAYMENTS) • Wisconsin’s Family Support Program (see SECTION 15.3.22 SPECIAL PROGRAMS) • Payments from Indian Health Services (Note: Payments to Native Americans listed in SECTION 15.3.14 PAYMENTS TO NATIVE AMERICANS must be counted.) This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 33.7 SeniorCare Participation Levels See 39.11 SENIORCARE INCOME LIMITS. This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008 33.8 SeniorCare Countable Costs 33.8.1 SeniorCare Countable Costs Introduction To count towards meeting a spenddown or deductible, the prescription drug purchase must be: 1. Prescribed for the eligible SeniorCare member, 2. Purchased during the benefit period, and 3. Covered by the SeniorCare program (see SECTION 33.6 FINANCIAL REQUIREMENTS). All covered prescription drug costs the member incurs will be tracked, and the SeniorCare Program will coordinate coverage with other insurance companies if the member has other coverage. If the prescription is covered by other insurance, only the portion not paid by other insurance is applied toward the spenddown or deductible. When a member’s out-of-pocket expense requirements are met for a deductible or spenddown, participating pharmacies will be informed. 33.8.2 Carryover There is no carryover of prescription costs from one benefit period to the next. There are two instances, within a benefit period, when carryover covered prescription amounts are applied. 1. When the covered prescription cost exceeds the remaining deductible amount, SeniorCare pays the difference. Example 1: Jeff earns between 160% and 200% of the FPL for a FTG size of one (39.11 SENIORCARE INCOME LIMITS AND PARTICIPATION LEVELS). He is eligible for SeniorCare and has a $500 deductible. In three months, Jeff has a remaining deductible amount of $30. During the fourth month of his benefit period, with a $30 remaining deductible, Jeff purchases a covered prescription drug that costs $100. The pharmacist informs him that he owes $30 of the $100 prescription drug cost. He has met his deductible. The remaining $70 will be paid by SeniorCare.