State of Illinois
Pat Quinn, Governor
Illinois Department on Aging
John Holton, Director
UPDATES
2011 Circuit Breaker
and Illinois Cares Rx
IL-1363 and Related
Schedules
Online Filing Application
• 235,326 in 2009
• 283,284 in 2010
• 303, 556 to date in 2011
BENEFITS OF ONLINE FILING
• Reduces the number of errors
• Reduces processing time
Seniors
Ride Free
Form IL-1363
Booklet
Seniors
Ride Free
Pages 1 and 2
Page 1
• The Senior Ride Free was added
Page 2
• In the “Contents” section removed the “Filing
on the Internet” and the Rebate Information
• In the “When May you Expect to Receive
your Benefits” section a question was added regarding the
transit card
Section A Page 3
Removed the People with Disabilities Ride Free Transit card at the top of
the page in the heading and now call the benefit the Ride Free Transit
Card.
Added civil unions to the status information on
2 & 3 of Line 6.
FORM IL -1363
Section C
– Income, losses and deductions for claimant and spouse
FORM IL -1363
Section C (continued) page 4
• Moved Line 24 from the 1st page of the
application to the top of the second page
• In Line 24b we added the word out
FORM IL -1363
Section D
The words “Line 2” were added
after Schedule B.
FORM IL -1363
Section E
• Two notes were combined into one
FORM IL -1363
Section F page 5
• All rebate information was removed for the claimant
FORM IL -1363
Section G
• Removed all rebate information for the spouse
FORM IL -1363
Section H
Section H
• Changed the amount for a married couple from $25,010 to $25,260
• Changed the amount for single individual from $12,516 to $12640
• Bolded the portion of the statement “If you are not married or you
do not live with your spouse
FORM IL -1363
Section I
Section I
•
Added Seniors Ride Free
FORM IL -1363
Section J page 6
•
Added the note under the preparer to attach proof of authority if
Someone else signs for you or your spouse
FORM IL -1363
Page 7
The amounts In the second column were changed to reflect
the new dollar amounts for income to qualify for IL Cares Rx
Page 8
• In the chart at the bottom of the page the numbers have all
been changed to reflect the ½ grant amount
• Under Item 1 on the chart “Line 25” should say Line 23
Page 9
Added the second question to explain civil unions and IL
Cares Rx
Page 10 and Page 11
Page 10
• No changes
Page 11
• Removed all of the rebate information
Pages 12 and 13
The stand alone coordinating plans
remained the same.
New Medicare Advantage Plans
have been added and some have
been removed. Be sure to recheck
the advantage plans if you are
enrolling someone
Page 14 and Page 15
Page 14
• Under #6 in the second column, status1 and 2 have the
words “civil union” added
Page 15
• No changes
FORM IL -1363
Page 16 and Pages 17,18 and 19
Page 16
•The $250 rebate when you reached the
coverage gap has been removed
Pages 17,18 and 19
• No changes
FORM IL -1363
Page 20 and Page 21
Page 20
• Removed the instructions regarding the
rebate in both Section F and Section G
Page 21
• Added the Senior Ride Free to Section I
FORM IL -1363
Pages 22,23 and 24
• No changes
FORM IL -1363
Schedule A
Seniors
Ride Free
Schedule A pages 25 and 26
• In the 1st statement under the heading “civil
union partner” was added
Schedule C
Seniors
Ride Free
SCHEDULE C pages 27,28,29 and 30
Page 27
• “Parties to a civil union must each file a
separate Schedule C” was added to the
statement after the heading.
Pages 28,29 and 30
• No changes
FORM IL -1363
Pages 31 and 32
Page 31
• The address on PSA 1 has changed
Page 32
• No changes
FORM IL -1363
Schedule B
Seniors
Ride Free
Schedule B:
• Removed the monthly Rebate questions
FORM IL -1363
Schedule P
Seniors
Ride Free
Schedule P pages 1,2,and 3
Pages 1 and 2
• No changes
Page 3
• The dollars amounts to apply for prescription coverage
were changed
Schedule P note
– A Schedule P will no longer cause a person who
files one to be eliminated from the other benefits
of Circuit Breaker. If you qualify for IL Care Rx
you will also qualify for all the other benefits
because the income guidelines for IL Cares Rx
are lower.
FORM IL -1363
ADAD-16
Seniors
Ride Free
ADAD-16 step 1
All rebate information has been
removed.
Adad-16 Step 2
All rebate information has been
removed for the spouse.
Adad-16 step 3
The savings, investments or real
estate for a married couple has
changed from $25,010 to $25,260
and for a single individual from
$12,510 to $12,640
Adad-16 step 4
All rebate information has been removed for
the QAR.
Amended Application
IL 1363X
Seniors
Ride Free
IL-1363 X note
An IL-1363X should not be used to change the in
formation in Section A of the form or to apply for
pharmaceutical coverage. Only in the case where
an individual has made an error in the numbers he
originally reported should an IL-1363X be used.
Changes to Section A should either be phoned , emailed or mailed to us.
Rx coverage can be applied for on the ADAD 16
form.
FORM IL -1363