HealthCare Choices Resource Center

Bulletin

Illinois Cares Rx Updates

January 25, 2012

New IL-1363 Online Application Available

The 2011 IL-1363 application form is now available online at the Department on Aging website. Booklets have been shipped to those who receive bulk orders; when the bulk shipment is completed, paper booklets will be sent to individual members.

Significant changes to the form include:

· Adding “civil union” to the “married” line throughout the form

· Transit Card question (Section I) now includes Seniors Ride Free (added to the previous People with Disabilities) and

· The Circuit Breaker Grant Estimate chart (page 8 in the paper application) now reflects the actual grant amounts. In last few years the chart listed an amount that was supposed to be reduced by 50%.

For a more detailed list of the changes, click on the attachment below.

Clarification on generic co-pays

There has been some confusion about the co-payment levels for generic drugs in coordinating PDPs that are not on Tier 1. According to the Department of Healthcare and Family Services (HFS), the co-pay is $5 for all generics in the AARP plan (Tiers 1 and 2), but co-pays for generics in the other plans depend on the tier level to which they are assigned. HFS provided the following clarification.

For AARP that has 5 tiers:

· Tier 1 – preferred generics - $5

· Tier 2 – non-preferred generics - $5

· Tier 3-- preferred brands - $15

· Tier 4 – non-preferred brands - $20

· Tier 5 – specialty - $15

Wellcare, CVS Caremark and First Health with 4 tiers:

· Tier 1 – preferred generics - $5

· Tier 2- non-preferred generics and preferred brands - $15

· Tier 3 – non-preferred brands - $20

· Tier 4 – specialty $15

Illinois Cares Rx Annual Member Letter

The Illinois Department of Healthcare and Family Services (HFS) mailed a four-page annual member letter to all individuals currently enrolled in the Illinois Cares Rx (ICRx) program beginning in late November. The letter includes information about how the ICRx benefit works, the 2012 coordinating plans, the ICRx co-pays, and contact information for local agencies if should they require any assistance or have questions. Click on the attachment below to view a copy of the letter.

2012 ICRx Wrap Request Form

The 2012 ICRx wrap request form should be used if an ICRx member in a coordinating plan is not receiving the wrap-around benefit. The wrap-around benefit includes payment of the monthly Part D plan premium, annual deductible and help paying for prescription drug co-pays if the member is enrolled in one of the coordinating plans (plans that work with ICRx).

If an individual is not receiving the wrap-around benefit, the counselor should

· first make sure the member has current ICRx eligibility and

· then contact the Part D plan and ask the representative to put the wrap benefit in place. Make sure to mention that he or she is an Illinois Cares Rx member.

If the plan representative is unable or will not wrap the member, you should then fax the Wrap Request form to HFS so they can work with the plan to be sure the member’s coordinating plan benefits are in place. Please remember to call the plan first. You only need to call them once. When completing the form make sure to fill out all of the information, including the name of the plan representative who was unable to wrap the member. Click on the attachments below to view the wrap request form and instructions on how to complete it.

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AgeOptions on behalf of the Make Medicare Work Coalition January 25, 2012