• Who qualifies as disabled?
• What if I am NOT a U.S. citizen?
• What if I become 65 years old in 2012?
• What if I am married?
• If my spouse died before applying, do I qualify?
• Who is a Qualified Additional Resident? Can I claim him/her on my application?
• What if I share my home with someone other than my spouse or any Qualified Additional Resident?
• What if I have other insurance that pays for my drugs?
• What if I have a drug discount card?

Apply on Form IL-1363 if you meet the following requirements:

1. Age
   • you must be 65 years of age or older before January 1, 2012; or
   • you must become 65 years of age during 2012 (benefits become available after you turn 65; your Circuit Breaker grant will be prorated based on the number of months you were 65 in 2012); or
   • you must be 16 years of age or older before January 1, 2012, and qualify as disabled; or
   • you must be a widow or widower who was 63 or 64 years of age before the death of your spouse, if your spouse was receiving or was eligible to receive Form IL-1363 benefits such as the Circuit Breaker grant, License Plate discount and/or Ride Free Transit Card.


2. Residency
   • you must live in Illinois at the time you file your application; and
   • you must continue to be a resident of Illinois to receive Illinois Cares Rx; and
   • you must have lived in an Illinois residence in 2011 that was subject to property or mobile home tax to be eligible for a Circuit Breaker grant.


3. Income Limit for Circuit Breaker grant, License Plate discount, and Ride Free Transit Card:
   Your* total income in 2011 must be less than
   • $27,610 if filing an application for yourself only; or
   • $36,635 if filing an application for yourself and your spouse*, or yourself and one Qualified Additional Resident; or
   • $45,657 if filing an application for yourself, your spouse* and at least one Qualified Additional Resident, or yourself and at least two Qualified Additional Residents.

     *You must include your spouse's income if married and living together on December 31, 2011. If your spouse died during 2011, you would file as single and claim only your income. Do NOT include the income of a Qualified Additional Resident.

     Projecting Your Income – If you have experienced an event that has decreased your income to less than the income limits for 2011, and you have met the age and residency requirements, you may qualify for drug coverage. For example, a qualifying event might be the death of a spouse during 2012, a divorce, the onset of a disability, or your spouse entering the nursing home.
     
     In order to qualify under these conditions, you must file Schedule P: Projected Income Schedule for Illinois Cares Rx Drug Coverage with your Form IL-1363.

   NOTE: To view the requirements for Illinois Cares Rx, see Do I also qualify for Illinois Cares Rx benefits? below.



4. Deadline
   Form IL-1363 must be postmarked on or before December 31, 2012. File earlier to get your benefits sooner.

If you want help paying for prescription drugs, see additional requirements below.

FIRST, do you meet the requirements for Form IL-1363? (See above.)
If YES, read below to see if you meet the Illinois Cares Rx requirements.

1. You would qualify for Illinois Cares Rx if:
   • You are filing an application for yourself only and your total income is less than $22,340; or
   • You are filing an application for yourself and your spouse*, or yourself and one Qualified Additional Resident and your total income is less than $30,260; or
   • You are filing an application for yourself and your spouse and a Qualified Additional Resident(s) and your total income is less than $38,180.
2. You would qualify for Illinois Cares Rx Plus if:
   • You meet the income qualifications stated above; and
   • You have Medicare; or – You are 65 years of age or older without Medicare; and
   • You are a U.S. citizen or qualified noncitizen.
3. You would qualify for Illinois Cares Rx Basic if:
   • You meet the income qualifications stated above; and
   • You do not have Medicare; and
   • You are 16 years of age or older but under age 65 and totally disabled, or 65 years of age or older and you do not meet the requirements for Illinois Cares Rx Plus.

   * You must include your spouse's income if married and living together on December 31, 2011. If your spouse died during 2011, you would file as single and claim only your income. Do not include the income of a Qualified Additional Resident.

NOTE: If your 2011 income was over these limits, see Projecting Your Income above.

To view the income limits for the Circuit Breaker grant, License Plate discount and Ride Free Transit Card, see Do I qualify for Form IL-1363 benefits? above.

4. If eligible for Medicare:
   • must have applied for "extra help" available under Medicare Part D through the Social Security Administration, and
   • must be enrolled in a coordinating Medicare Part D Prescription Drug Plan.

To qualify as disabled, you must be at least 16 years of age and
receive disability benefits from one of the following:

• Social Security Administration, or
• Veterans Administration, or
• Civil Service, or
• Railroad Retirement,

• a Class 2 disability card from the Illinois Secretary of State's office, or
• a completed Schedule A: Physician's Statement if you are not yet age 65 and do not have other proof of disability as listed above.

NOTE: Use a separate Schedule A for each person who is not yet age 65 and needs to send us other proof of disability. You must attach proof of disability.

A Qualified Additional Resident is an individual, other than your spouse,

• who lived with you in the same residence in 2011 and in 2012 at the time you file your 2011 Form IL-1363; and
• for whom you, or you and your spouse, provided more than half of that person’s total financial support in 2011; and
• who is not filing a separate 2011 Form IL-1363.

A Qualified Additional Resident may receive prescription drug benefits, a Circuit Breaker grant, License Plate discount and a People with Disabiities Ride Free transit card if he or she files a separate 2011 Form IL-1363 in his or her own name. A person cannot file a separate Form IL-1363 and also be reported as a Qualified Additional Resident on another application for the same year.

You do not have to be a U.S. citizen to qualify for a Circuit Breaker grant, License Plate discount, or Illinois Cares Rx BASIC prescription drug benefits.

However, if you are age 65 or older and want to apply for Illinois Cares Rx PLUS prescription drug benefits, there is an additional requirement.

Illinois Cares Rx PLUS requirements for noncitizens

To check the "qualified noncitizen" box in Line 30 in Section F (Line 33, Section G, for your spouse) of the Form IL-1363 application booklet, you must be a noncitizen who is also one of the following:

1. a lawful permanent resident who has lived in the U.S. for at least five years;
2. a refugee, an asylee, or a parolee;
3. a U.S. veteran or the spouse of a U.S. veteran;
4. a national of Cuba or Haiti admitted to the U.S. on or after April 21, 1980;
5. an Amerasian from Vietnam admitted though the Orderly Departure Program beginning on March 20, 1988;
6. identified by the federal Office of Refugee Resettlement as a victim of trafficking;
7. a member of Hmong or Highland Laotian tribe during the Vietnam era between August 5, 1968, and May 7, 1975 (this includes the person’s spouse, widow, or widower who has not remarried);
8. an American Indian born in Canada to whom Section 289 of the Immigration and Nationality Act applies or a member of an Indian tribe defined in Section 4e of the Indian Self-Determination and Education Assistance Act;
9. a victim of domestic abuse; or
10. your deportation is being withheld by INA under Section 243(h) or Section 241(b)(3).

You may need to attach proof of your qualified noncitizenship status by submitting one of the following documents:

• Alien Registration Receipt Card (I-151)
• Permanent Resident Card (I-551)
• Memorandum of Creation of Record of Lawful Permanent Residence (I-181)
• Arrival-Departure Record (I-94)
• Other Department of Homeland Security (U.S. Citizenship and Immigration Services) documents
• U.S. military discharge papers or current orders (DD Form 214, Report of Separation)

You may apply for

• a partial grant based on the number of months you were 65 years of age in 2011, (we issue grants after you turn 65); and
• prescription coverage. If you wish to receive coverage as soon as possible after you turn 65, you should apply at least three months before your birthday.

If you are married and you and your spouse lived together during 2011, you must complete one Form IL-1363 and report your total combined income. Your spouse cannot apply separately.

If one or both of you resided in a nursing home, you should each complete separate Forms IL-1363.

If you and your spouse were permanently separated in 2011 and are living at different addresses, you may each complete separate Forms IL-1363. If you file as a surviving spouse, then only your income will be counted in determining household income.

If your spouse died in 2011 or 2012 before sending us a properly completed 2011 Form IL-1363, you may qualify. You must meet the requirements listed above under Form IL-1363 Requirements.

You must complete Form IL-1363 in your own name. Be sure to read the instructions for line 6 on page 14 of the Form IL-1363 application booklet to determine the correct box to check for your situation.

You must attach proof of your age. (For examples, see page 24 of the Form IL-1363 application booklet.)

If you were 63 or 64 years of age before the death of your spouse and your spouse was receiving or was eligible to receive Form IL-1363 benefits,

You must also attach proof of your spouse's death. (For examples, see page 24 of the Form IL-1363 application booklet.) You may only qualify for a Circuit Breaker grant and License Plate discount and/or Transit Card. You become eligible for Illinois Cares Rx benefits upon reaching age 65.

A person who lives with you (other than your spouse or Qualified Additional Resident) may apply on a separate Form IL-1363, if he or she meets the requirements listed above under Form IL-1363 Requirements.