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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 .

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State of Illinois

Pat Quinn, Governor

Illinois Department on Aging

John Holton, Director

online filing application
Online Filing Application
  • 235,326 in 2009
  • 283,284 in 2010
  • 303, 556 to date in 2011


  • Reduces the number of errors
  • Reduces processing time


Ride Free

form il 1363 booklet

Form IL-1363 Booklet


Ride Free

pages 1 and 2
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
Section A Page 3
  • Personal information about claimant

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.

section c
Section C
  • Income, losses and deductions for claimant and spouse
section c continued page 4
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
section d

Section D

The words “Line 2” were added after Schedule B.


Section E

  • Two notes were combined into one

Section F page 5

  • All rebate information was removed for the claimant

Section G

  • Removed all rebate information for the spouse
section h

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
section i

Section I

Section I
  • Added Seniors Ride Free

Section J page 6

  • Added the note under the preparer to attach proof of authority if

Someone else signs for you or your spouse

page 7

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

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 and Page 15

Page 14

  • Under #6 in the second column, status1 and 2 have the words “civil union” added
  • Page 15
  • No changes
page 16 and pages 17 18 and 19

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

page 20 and page 21
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
schedule a
Schedule A


Ride Free

schedule a pages 25 and 26
Schedule A pages 25 and 26
  • In the 1st statement under the heading “civil union partner” was added

Schedule C


Ride Free

schedule c pages 27 28 29 and 30
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
pages 31 and 32
Pages 31 and 32

Page 31

  • The address on PSA 1 has changed

Page 32

  • No changes

Schedule B


Ride Free

schedule b
Schedule B:
  • Removed the monthly Rebate questions
schedule p
Schedule P


Ride Free

schedule p pages 1 2 and 3
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
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.
adad 16


Ride Free

adad 16 step 1

ADAD-16 step 1

All rebate information has been removed.

adad 16 step 2

Adad-16 Step 2

All rebate information has been removed for the spouse.

adad 16 step 3

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
Adad-16 step 4

All rebate information has been removed for the QAR.

il 1363 x note

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 , e-mailed or mailed to us.

Rx coverage can be applied for on the ADAD 16 form.