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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Care Wisconsin Medicare Dual Advantage ATTN: Pharmacy Services 1617 Sherman Ave Madison, WI
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How to fill out care wisconsin medicare dual

01
To fill out the Care Wisconsin Medicare Dual, follow these steps:
02
Gather all the necessary information and documents, including your personal information, Medicare and Medicaid numbers, and any additional information related to your healthcare needs.
03
Contact Care Wisconsin to request an application form or visit their website to download the form.
04
Fill out the application form accurately and completely. Provide all the requested information and make sure to double-check for any errors before submitting.
05
Include any supporting documents required, such as proof of income or disability.
06
Review your application to ensure that all the information provided is correct and up-to-date.
07
Submit the completed application form and any supporting documents to Care Wisconsin, following their specified instructions.
08
Wait for a response from Care Wisconsin regarding your application. They will review your eligibility and inform you of the next steps.
09
Follow up with Care Wisconsin if you do not receive a response within a reasonable time frame. You may need to provide additional information or clarification.
10
Once your application is approved, you will receive your Care Wisconsin Medicare Dual coverage.

Who needs care wisconsin medicare dual?

01
Care Wisconsin Medicare Dual is designed for individuals who meet the following criteria:
02
Must be eligible for both Medicare (age 65 and older or under 65 with certain disabilities) and Medicaid (income and resource requirements).
03
Require long-term care services and support, such as home care, assisted living, or nursing home care.
04
Have healthcare needs that are best managed through the coordination of Medicare and Medicaid services.
05
Reside in the state or service area covered by Care Wisconsin.
06
If you or a loved one meet these requirements, you may be eligible for Care Wisconsin Medicare Dual coverage.
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Care Wisconsin Medicare Dual is a program that combines Medicare and Medicaid to provide healthcare coverage for individuals who are eligible for both programs.
Individuals who are eligible for both Medicare and Medicaid are required to file for Care Wisconsin Medicare Dual.
To fill out Care Wisconsin Medicare Dual, individuals can contact the Care Wisconsin office or visit their website to complete the necessary forms.
The purpose of Care Wisconsin Medicare Dual is to simplify healthcare coverage for individuals who qualify for both Medicare and Medicaid.
Information such as income, medical expenses, and other relevant documentation must be reported on Care Wisconsin Medicare Dual.
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