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If you have Medicare, Illinois Cares Rx will provide additional coordinating benefits.
If you do not have Medicare, Illinois Cares Rx provides two benefits: Illinois Cares Rx BASIC and Illinois Cares Rx PLUS.
Who may get Illinois Cares Rx prescription drug benefits?
A claimant or claimant’s spouse who meets the requirements and applies each year may get Illinois Cares Rx prescription drug benefits. The information on your Form IL-1363 application will determine your prescription drug benefits.
Each person approved for Illinois Cares Rx prescription drug benefits will get a card under his or her own name. Persons eligible for Medicare who want to receive coordinating benefits MUST enroll themselves in a coordinating Medicare prescription drug plan. In addition to the Illinois Cares Rx card, you will receive an identification card from your Medicare Part D prescription drug plan to use at the pharmacy.
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Frequently Asked Questions
Answers provided to the following questions are meant only to give general guidance and not legal advice. The answers do not replace legal requirements set by applicable federal or state laws and regulations.
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How do the federal and state programs work?
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Medicare Part D
You can get the Medicare Part D prescription drug benefit if you are entitled to Medicare Part A and/or enrolled in Medicare Part B.
For more information on the Medicare Part D program,
- call the Centers for Medicare & Medicaid Services toll-free at 1-800-MEDICARE (1-800-633-4227), 1-877-486-2048 (TTY) or visit www.medicare.gov
- call the Senior Health Insurance Program (SHIP) toll-free at 1-800-548-9034, 1-217-524-4872 (TDD). (SHIP, a free statewide health insurance counseling service, will also provide help choosing a Medicare Part D plan.)
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Frequently Asked Questions on Medicare Part D
When is the Medicare Open Enrollment Period?
Medicare’s open enrollment period begins on November 15 and continues through December 31 of each year. During the open enrollment period, people with Medicare may choose to switch to a different Medicare Part D drug plan for prescription drug benefits beginning the following January 1.
NOTE: Carefully evaluate your current Medicare Part D prescription drug plan to see if it will continue to meet your anticipated needs. Your plan is required to send an annual notice if there are any changes in benefits, covered drugs on a formulary, participating pharmacies, or expenses (premiums, deductibles, co-payments, or co-insurance). If you take no action, you will remain in your current plan until the next available enrollment period.
Do you have to switch Medicare Part D plans each year?
No. If you are enrolled in a Medicare Part D drug plan coordinating benefits with Illinois Cares Rx and you are happy with your benefits, you do not need to choose a new Medicare Part D drug plan during the Medicare open enrollment period.
How do you switch to a different coordinating Medicare Part D drug plan?
If you wish to switch to a different Medicare Part D drug plan coordinating benefits with Illinois Cares Rx, you must contact the coordinating Medicare Part D drug plan that you wish to switch to during Medicare’s open enrollment period, November 15 through December 31, and identify yourself as an "Illinois Cares Rx member". Do not call the plan you are currently enrolled in to switch or disenroll. You do not need to contact the Illinois Department on Aging or the Illinois Department of Healthcare and Family Services to switch plans.
Should you enroll in a Medicare Part D drug plan on your own?
YES. You may contact one of the coordinating Medicare Part D plans to enroll on your own. If you have enrolled in a Medicare Part D drug plan on your own, you can let us know by answering Line 31b for you and 34b for your spouse on the Form IL-1363.
If you are not receiving "wrap around" benefits, YOU must call the Health Benefits Hotline: 1-800-226-0768, 1-877-204-1012 (TTY).
What is the Medicare Part D late enrollment penalty?
If you did not join a Medicare Part D drug plan when you first became eligible, and you do not have creditable drug coverage, you may be billed a late enrollment penalty. The penalty is at least 1 percent of the average national premium for each month of delay. This penalty is in addition to your monthly premium. Illinois Cares Rx will not pay any late enrollment penalty.
What is a Special Enrollment Period?
Under certain circumstances, you may be able to enroll or switch plans by using a Special Enrollment Period (SEP). As a member enrolled in Illinois Cares Rx, you have one SEP each year to join a Medicare Part D drug plan for the first time or to change to another plan, including joining a plan that coordinates with Illinois Cares Rx.
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Illinois Cares Rx
You can get the new Illinois Cares Rx prescription drug benefits if you meet the requirements. Complete Form IL-1363 (plus any required schedules) and send it to us as soon as possible. To apply or reapply for help paying for prescription drugs, you should fill in Section F for yourself (Section G for your spouse) on Form IL-1363. These questions relate to Medicare Part D. Make sure you carefully read and follow all of the form instructions.
If you have original Medicare (Part A and/or Part B)...
- apply for "extra help" available online under Medicare Part D through the Social Security Administration.
"Extra help" is a program available through the Social Security Administration which offers additional financial assistance with prescription drug costs under Medicare Part D for qualifying individuals with limited income and resources. (It is not an application for coverage under a prescription drug plan.)
If you need an "extra help" application or want to check on the status of your "extra help"
application, call the Social Security Administration toll-free at 1-800-772-1213, 1-800-324-0778 (TTY). You may also apply for "extra help" on the Internet at
www.socialsecurity.gov.
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"Extra Help"
First time filers: You must apply for “extra help” in order to qualify for Illinois Cares Rx. It is important that you complete your “extra help” application and send it in for a decision even if you do not think you will be eligible. Make sure you keep a copy of this decision for your records.
Current Illinois Cares Rx members: If you currently have "extra help" under Medicare Part D, you do not have to reapply unless notified to do so by the Social Security Administration. Be sure to follow the directions provided in any "extra help" redetermination letter. You should also contact the Social Security Administration to determine if you should reapply for "extra help" if there is any change in your circumstances after your application is approved or denied.
NOTE: If you are not determined eligible for “extra help”, you may still receive prescription drug benefits under Illinois Cares Rx.
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- enroll in a coordinating Medicare Part D prescription drug plan.
- If you have original Medicare (Part A and/or Part B), there are five stand-alone prescription drug plans coordinating benefits with Illinois Cares Rx:
- First Health Part D – Premier,
- Humana Value,
- SilverScript,
- AARP Saver Plan, and
- WellCare Classic.
Once your Form IL-1363 is approved and you are enrolled in a coordinating Medicare Part D prescription drug plan, we will pay your monthly premium for a basic Medicare drug benefit (excluding any late enrollment penalty) and also help pay your annual deductible, co-insurance, and the coverage gap.
If you are enrolled in a non-coordinating Medicare Part D prescription drug plan, we will ONLY pay your monthly premium for a basic Medicare benefit available from these other plans. We will NOT help pay your annual deductible, co-insurance, or the coverage gap. You may choose a $25 monthly rebate as your Illinois Cares Rx benefit.
- There are ten companies coordinating Medicare Advantage plans with Illinois Cares Rx that have agreed to coordinate benefits with Illinois Cares Rx:
- Erickson,
- Essence,
- Evercare,
- Group Health Plan (GHP),
- Health Alliance Medical Plans,
- HealthSpring,
- Humana,
- Personal Care,
- SecureHorizons by United Healthcare and
- Wellcare.
Medicare Advantage plans may be available in only certain counties in the state. These plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans and Medicare Special Needs Plans.
If you are enrolled in a coordinating Medicare Advantage plan, we will pay your monthly premium for a basic Medicare benefit (excluding any late enrollment penalty) and also help pay your annual deductible, co-insurance, and the coverage gap.
If you are enrolled in a non-coordinating Medicare Advantage plan, we will ONLY pay your monthly premium for a basic Medicare benefit (excluding any late enrollment penalty). We will NOT help pay your annual deductible, co-insurance, or the coverage gap. Instead of Illinois Cares Rx paying for your monthly premium for a basic Medicare benefit plan, when you are enrolled in a non-coordinating Medicare Advantage plan, you may choose a $25 monthly rebate as your Illinois Cares Rx benefit.
If you are enrolled in a non-coordinating Medicare Advantage plan, you have three options:
- stay with your current Medicare Advantage plan and go without your full coordinated benefits under the Illinois Cares Rx program (only your monthly premium for a basic Medicare benefit will be paid), or
- switch to a coordinating Medicare Advantage plan (if available in your area) by contacting that plan, or
- leave the non-coordinating Medicare Advantage plan by enrolling in a coordinating stand-alone Medicare Part D prescription drug plan.
NOTE: If you switch or leave a Medicare Advantage plan:
- You will be automatically disenrolled from your current plan.
- Your health care benefits may be affected.
For more information:
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First-time Filers
If you are a first-time filer for prescription drug benefits on Form IL-1363, are eligible for Medicare, and are not
currently enrolled in a Medicare Part D prescription drug plan, you MUST contact one of the coordinating plans and enroll on your own. Be sure to tell the coordinating plan that you want coordinating coverage with Illinois Cares Rx.
To begin receiving your coordinating benefits, you MUST call the Health Benefits Hotline: 1-800-226-0768, 1-877-204-1012 (TTY).
You have the right to pick any other Medicare Part D prescription drug plan serving Illinois. You will not receive
Illinois Cares Rx "wrap around" benefits if you enroll in a non-coordinating Medicare Part D plan.
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If you do NOT have Medicare...
Illinois Cares Rx provides two benefit plans – BASIC and PLUS. For more information, download the Illinois Cares Rx brochure (PDF) or link to www.illinoiscaresrx.com.
You may also be eligible for an additional discount on certain prescription drugs through the Illinois Rx Buying Club. For more information on the Illinois Rx Buying Club, link to www.illinoisrxbuyingclub.com.
For more information, see also Will there be out-of-pocket expenses?
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What drugs are covered? [ top ]
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Illinois Cares Rx BASIC covers drugs used in the treatment of the following diseases –
- Alzheimer’s disease
- Arthritis
- Cancer
- Diabetes (including insulin, syringes and needles)
- Glaucoma
- Heart and blood pressure problems
- Lung disease and smoking-related illnesses
- Multiple sclerosis
- Osteoporosis
- Parkinson’s disease
Illinois Cares Rx PLUS covers almost all prescription drugs. For persons who have a diagnosis of HIV/AIDS, it provides an alternative co-payment according to whether or not a drug is covered by the Medicare Part D Prescription Drug Plan in which the beneficiary is enrolled (in addition to whether or not the drug is included in the formulary of the Illinois AIDS Drug Assistance Program operated by the Illinois Department of Public Health.)
Illinois Cares Rx BASIC and Illinois Cares Rx PLUS cover both generic drugs and brand name drugs. The preferred drug list (PDL) is a list of some types of drugs, but not all, that are covered by your card.
Most drugs listed as "preferred" on the PDL can be obtained at a participating pharmacy without
any additional approval required.
A drug that is listed as "non-preferred" requires an extra step called prior approval before the program will pay for it.
Your pharmacy or doctor’s office may call to request prior approval of a non-preferred drug. If the request is approved, your pharmacy will be able to fill your prescription within 24 hours. If the request is denied, you will receive a denial letter in the mail. You have the right to appeal the denial of a prior approval request.
Your doctor can use your plan’s preferred drug list to prescribe a preferred product if it is medically appropriate.
For more information, download the Illinois Cares Rx brochure (PDF) or link to www.illinoiscaresrx.com.
NOTE: If you have Medicare and receive your prescription drug benefits through a coordinating Medicare Part D prescription drug plan, you must follow your plan’s formulary (see Coordinating PDPs).
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Illinois Cares Rx AIDS Drug Assistance
Illinois Cares Rx provides an additional coordinating benefit for individuals who have Medicare and a diagnosis of HIV/AIDS.
Your co-payments will be $2.50 for generic drugs and $6.30 for brand name drugs for the entire calendar year for drugs on the AIDS Drug Assistance Program (ADAP) formulary that are also on the coordinating Medicare Part D prescription drug plan formulary.
Your co-payments for all other covered Illinois Cares Rx drugs will be $2.50 for generic drugs, $6.30 for preferred brand name drugs, and $15 for non-preferred brand name or specialty drugs. After $2,830 in benefits has been paid on your behalf, you must pay your co-payment plus 20 percent of the cost of each prescription. After $6,440 in prescription drug costs, your share of costs will drop to the co-payment plus 5% of the cost of each prescription.
For drugs not covered by Illinois Cares Rx BASIC, you will receive the basic Medicare benefit but your co-payments may be higher. You will not receive the coordinating benefits on these drugs.
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Will there be out-of-pocket expenses? [ top ]
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With Medicare, your out-of-pocket expenses might include:
Co-payments*
- $2.50 for generic drugs
- $6.30 for preferred brand name drugs
- $15 for non-preferred brand name drugs
- $15 for specialty drugs
Without Medicare, your out-of-pocket expenses might include:
Co-payments
- $2.50 for generic drugs
- $6.30 for brand name drugs
*For drugs on the AIDS Drug Assistance Program (ADAP) formulary that are also on the coordinating Medicare Part D prescription drug plan formulary, your co-payments will be $2.50 for generic drugs and $6.30 for brand name drugs for the entire plan year.
If you are in Illinois Cares Rx PLUS, you pay 20% of each prescription plus the applicable co-payment after $2,830 in benefits. After $6,440 in prescription drug costs, your share of costs will drop to 5% plus co-payment for each prescription.
If you are in Illinois Cares Rx BASIC, you pay 20% of each prescription plus the applicable co-payment after $1,750 in benefits.
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May I choose between Illinois Cares Rx BASIC and Illinois Cares Rx PLUS? [ top ]
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No. A person who qualifies for drug coverage will only qualify for one type of coverage. We will send you a drug card and information about your coverage. For more information, download the Illinois Cares Rx brochure (PDF) or link to www.illinoiscaresrx.com. Also see How do the federal and state programs work?.
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What if I have other insurance that will pay for my drugs? [ top ]
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Even if you have other insurance that will pay for prescription drugs, you can still benefit from the Illinois Cares Rx program.
- If you are eligible for Medicare and enrolled in a coordinating Medicare prescription drug plan, Illinois Cares Rx will help pay some of the Medicare costs for you. We will help pay your monthly premium, annual deductible, co-insurance, and the coverage gap.
- If you have full Medicaid benefits under the MediPlan card, you are NOT eligible for Illinois Cares Rx BASIC prescription drug benefits. If you are on the Medicaid Spend-Down program, you may still qualify for Illinois Cares Rx BASIC or Illinois Cares Rx PLUS prescription drug benefits.
- You may choose to receive a $25 monthly rebate instead of Illinois Cares Rx prescription drug benefits if you have other insurance that pays for prescription drugs. See Illinois Cares Rx rebate for more information.
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What if I have a drug discount card? [ top ]
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You may use your Illinois Rx Buying Club card to purchase medicine that is not covered by Illinois Cares Rx.
For more information on the Illinois Rx Buying Club, link to www.illinoisrxbuyingclub.com.
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How will I know if and when my coverage has been approved? [ top ]
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For new coverage: We will send you an Illinois Cares Rx card approximately 6 weeks following approval of your completed Form IL-1363.
For renewal coverage: We will mail a new Illinois Cares Rx card to you confirming renewal of your coverage about seven days before your current coverage is scheduled to expire. Remember though, an IL-1363 Circuit Breaker application must be filed each year.
You may periodically check on your approval status by linking to Check Your Application Status.
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When may I expect my prescription drug benefits to begin and how long will my coverage last? [ top ]
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If you are applying for the first time, your prescription drug benefits will begin within approximately 6 weeks following approval of your application; and it will end December 31, 2011.
If you are applying for a renewal card, your benefits will begin January 1, 2011; and it will end December 31, 2011.
NOTE: Your application will be delayed if we need to request additional information from you.
Remember... we can process applications filed on the Internet faster than those we receive in the mail.
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How can I get the most benefit from my Illinois Cares Rx card? [ top ]
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- Complete your Form IL-1363 as soon as you have the necessary information.
- File your completed application with us on the Internet (if you qualify).
- If eligible for Medicare (Part A and/or Part B):
1) apply for "extra help" available under Medicare Part D through the Social Security Administration, and
2) enroll in a coordinating Medicare Part D prescription drug plan to receive coordianting benefits. Once you have enrolled in a coordinating plan, YOU MUST call the Health Benefits Hotline: 1-800-226-0768, 1-877-204-1012 (TTY), to begin receiving your coordinating benefits.
- Ask your doctor to prescribe a generic drug for you. Generic drugs are usually less expensive than brand name drugs. When a generic drug is not available, ask your doctor to prescribe a preferred product from a preferred drug list, if medically appropriate.
- Check with your pharmacist to make sure your coverage will be honored.
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What if my prescription coverage card is lost or stolen? [ top ]
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If you lose your card or it is stolen, and you wish to receive a replacement card, you should notify us at the addresses or telephone numbers below.
- Illinois Department of Healthcare and Family Services
P.O. Box 19158
Springfield, IL 62794-9158
Call:
1-800-226-0768, 1-877-204-1012 (TTY)
E-mail:
Illinois Cares Rx
- Illinois Department on Aging
P.O. Box 19021
Springfield, IL 62794-9021
Call:
1-800-624-2459, 1-888-206-1327 (TTY)
E-mail:
Circuit Breaker Program
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What if I want more information about Illinois Cares Rx? [ top ]
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For more information on Illinois Cares Rx,
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