Gov. Tony Evers and the Wisconsin Department of Health Services (DHS) announce Wisconsin’s SeniorCare Program has received approval from the Centers for Medicare & Medicaid Services (CMS) to cover certain vaccines that members receive in pharmacies. Vaccines covered include those that protect against shingles, tetanus, meningitis, and Hepatitis A and B. These vaccines are recommended by the Advisory Committee on Immunization Practices(link is external) (ACIP) for adults aged 65 and older.
“Access to health care shouldn’t just be for the healthy and the wealthy, and that’s why we’ve worked hard to expand coverage for aging and older adults by fully funding SeniorCare, pushing for BadgerCare expansion, and proposing comprehensive legislation to reduce prescription drug prices,” said Gov. Evers. “Requiring SeniorCare to cover vaccines is another important step in ensuring older adults can get the care they need and stay healthy.”
Members with other insurance that covers vaccines, such as Medicare Part D, must first utilize their primary coverage and then SeniorCare will cover any copays or deductibles when vaccines are delivered in a pharmacy. SeniorCare members with Medicare Part B coverage must use Medicare Part B coverage to get certain vaccines—those that protect against the flu, pneumonia, or COVID-19. Members should check their plans and work with their providers to find where they can get vaccines under their coverage.
SeniorCare can only pay for vaccines provided and billed for at a pharmacy. To receive a SeniorCare-covered vaccine at a pharmacy, members should call ahead for information about what vaccines are available and how to schedule appointments. They should bring their SeniorCare card with them when they go. Members will be able to take advantage of this benefit later this month after they receive notice by mail.
“Vaccines offer critical protection from disease for people of any age,” said DHS Secretary-designee Karen Timberlake. “Being able to help Wisconsin’s seniors get many of the vaccines they need at their local pharmacies continues the success we’ve had in working with our pharmacy partners to make vaccines more accessible in communities across Wisconsin. By expanding vaccine coverage for the SeniorCare Program, we hope to see an increase in vaccination rates for preventable diseases.”
Created in 2002, SeniorCare is a prescription drug assistance program for Wisconsinites who are 65 years of age or older. In April 2019, Gov. Evers announced(link is external) that CMS had approved a 10-year extension of the waiver that allows the state to offer the program. The governor first proposed requiring SeniorCare to cover vaccines in a package of COVID-19 relief legislation he announced(link is external) in April 2020, and the Legislature later included the provision in 2019 Wisconsin Act 185(link is external). Currently more than 100,000 seniors are enrolled in the program.