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Changes to IL Cares Rx and the Ride Free Program

Changes to IL Cares Rx and the Ride Free Program. IL Cares Rx. Income guidelines have decreased: Current New 1 person household $27,610 $21,780 2 person household $36,635 $29,420 3 + person household $45,657 $37,060. IL Cares Rx.

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Changes to IL Cares Rx and the Ride Free Program

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  1. Changes to IL Cares Rx and the Ride Free Program

  2. IL Cares Rx Income guidelines have decreased: Current New 1 person household $27,610 $21,780 2 person household $36,635 $29,420 3 + person household $45,657 $37,060

  3. IL Cares Rx • As of September 1, 2011 the $25 Rebate will no longer be offered. As of 7/25/2011 the Circuit Breaker program is no longer accepting rebate requests. • For those people who are now receiving the rebate, their August check sent in September 2011 will be there last rebate check.

  4. IL Cares Rxwith Medicare Co-pays will change to: • $5 for Generic Drugs • $15 for Preferred Brand Name Drugs • $20 for Non-Preferred Brand Name Drugs • $15 for Specialty Drugs • After the total cost of your drugs (the amount you and your plan pay together) reaches $2840, you will pay 25% of the cost of each prescription, plus the appropriate co-payment. • If you have the full Low Income Subsidy (LIS) your co-payments and cost sharing will not change.

  5. IL Cares RxWith Medicare • If you were receiving the rebate and now wish to receive IL Cares prescription coverage and you meet the new income guidelines you must sign up for a medicare part D coordinating plan and you must fill out a Low Income Subsidy (LIS) application with Social Security. • IL Cares will pay the premium and the deductable on a coordinating plan.

  6. IL Cares RxWithout Medicare • $5 for Generic drugs • $15 for Preferred Brand Name Drugs • 25% of the cost of each prescription, plus the applicable co-payment after IL Cares Rx pays $1750 in benefits. • If you have medicaid, your co-payments will not change.

  7. IL Cares RxTerminated Participants If you have medicare • You will continue to receive prescription coverage through your part D plan • If your part D plan has a premium you will have to pay the premium in order to maintain coverage • If you have a remaining deductable under your part D plan, you will also be responsible for that deductable • If you choose to change your part D plan you must enroll between July 1 and October 31, 2011

  8. IL Cares RxTerminated Participants • If you do not have medicare • Beginning September 1, 2011 you will be responsible for paying the full costs of your medications • If you have V.A. coverage, private insurance, Medicaid or a discount program, that coverage will remain the same.

  9. IL Cares RxTerminating Participants If you do not meet the income guidelines for IL Cares Rx there are 2 options for people who qualify. 1. If the individual has had an unusual event occur that has caused their income to decrease to a qualifying level since filing their application they may want to file a Schedule P.

  10. IL Cares RxTerminating Participants • If the terminating participant has an individual that resided in their home during 2010 and in 2011 at the time they filed they 2010 IL-1363; and for whom the claimant, or the claimant and their spouse , provided more than half of that person’s financial support in 2010; and

  11. IL Cares RxTerminating Participants the individual is not filing a separate 2010 form IL-1363. The claimant may file an amended return and a Schedule B claiming a Qualified Additional Resident (QAR).

  12. IL Cares RXTerminating Participants • If a QAR is added to an amended application the QAR’s income is not included in the total income on the IL-1363 thereby allowing possibly the claimant, spouse and the QAR to qualify for IL Cares Rx at a higher income level.

  13. IL Cares RxTerminated Participants • Individuals with HIV/AIDS • Should contact the IL Dept of Public Health. They have programs that may be able to assist with prescription medicines and health insurance premiums • The Aids Drug Assistance Program (ADAP) offers 80 FDA approved drugs for the treatment of HIV/AIDS. Applications can be obtained on line at www.idph.state.il.us and www.hivcareconnect.com

  14. IL Cares RxDetermining Who Qualifies • If a person filed a 2009 application and currently had coverage in IL Cares we checked the income to see if the individual qualified on that application. If they did qualify they will maintain that coverage until 12/31/2011. They must file a 2010 application and meet the income guidelines in order to continue coverage through 12/31/2012.

  15. IL Cares Rx • If the individual had current coverage but did not meet the income guidelines from the 2009 application we checked the 2010 application if it had been filed. If the 2010 application met the income limits, the person was issued coverage that will be good through 12/31/2012 with no lapse. • If the person does not fall into either of the above categories, coverage will be terminated as of 9/1/2011.

  16. Circuit Breaker The income guidelines for all other Circuit Breaker benefits will remain the same. • $27,610 for a 1 person household • $36,635 for a 2 person household • $45,657 for a 3 person household

  17. Seniors Ride Free Program

  18. Seniors Ride Free • In addition to the Disabled Ride Free program under Circuit Breaker, we have also added the Seniors Ride Free Program. • The Seniors Ride Free Program is for those individuals 65 and over who meet the Circuit Breaker income guidelines to ride all fixed route mass transit buses and trains for free.

  19. Seniors Ride Free • Seniors that do not qualify for Circuit Breaker will be allowed to ride mass transit fixed routes at a reduced rate. • Once the Circuit Breaker application has been approved all seniors are sent a postcard that tells them they are now eligible for the free ride.

  20. Seniors Ride Free • Each mass transit district has it’s own requirements as to what can be used for identification purposes to obtain the free ride. Individuals should contact their own mass transit authority in order to find out what is required, once they receive our postcard telling them that they are approved.

  21. Seniors Ride Free • The law requiring that seniors who wanted to ride free on mass transit fixed routes must meet Circuit Breaker income requirements was passed last spring and required to be instituted by September 1, 2011. As of mid July 2011 the program is up and running.

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