October 2024
If you have a Medicare Advantage plan, you may have unused savings sitting in your wallet. The reason: Most Medicare Advantage plans give you money to pay for approved over-the-counter (OTC) medicine and products. However, only 30% of OTC benefit money is used each year, according to the Consumer Health Products Association (CHPA).
Here’s what you need to know about OTC benefit cards so you stop paying out of pocket for common drugstore items and start saving today.
What are Medicare Advantage OTC benefits?
Medicare Advantage OTC benefits pay for certain over-the-counter medicines and products. Your plan will have a formulary, or catalog, of what your OTC benefit will cover. Most plans send the catalog to you in the mail when you enroll. Your plan’s online portal may also list what items your plan will and won’t cover. You can shop for these items at participating retailers, including your local independent pharmacy if they accept OTC benefit cards.
Common categories most OTC benefits cover include:
- Oral and dental care products
- Ear and eye care products
- Cough, cold, and allergy medicine
- Pain and fever relief medicine
- Stomach remedies, such as for acid reflux
- First aid supplies
- Leg and foot care products
- Orthotic braces and orthopedic support
- Skin health products, such as eczema cream or sunscreen
- Bath and safety products
- Adult incontinence underwear and products
- Home medical equipment, such as home blood pressure monitors
- Vitamins and supplements
- Medication management supplies
How do you get OTC benefit money?
Most Medicare Advantage plans treat OTC benefits as an allowance. They give you a certain dollar amount to spend each month, quarter, or year. Oftentimes, the money does not roll over, so if you don’t use it during that time period, it’s gone.
According to CHPA, the average OTC benefit allowance is about $400 each year, or $100 every three months. Depending on your plan, you may get more or less.
If your plan offers OTC benefits, they will preload the money onto either your plan card or onto a separate OTC benefit card. Either way, you can use the benefit card like a debit card at your local drugstore.
When you go to pay for your items, hand the cashier the appropriate card. Through item coding, the card identifies what products it covers. If a product you want to buy isn’t covered or if you go over your allowance, you will have to pay out of pocket.
How do you find out if you have OTC benefits?
With 70% of OTC benefit money unused each year, it seems many people either don’t know they have the benefit or don’t know how to use it.
Check your wallet to see if you have an OTC benefit card from your Medicare Advantage plan that you forgot about. Some 80% of Medicare Advantage plans offer OTC benefits, according to CHPA.
If you don’t have such a card, call the customer service number on the back of your Medicare card and ask about OTC benefits. Your plan may also have this information on your online portal.
How can you get OTC benefits?
OTC benefits are not part of regular Medicare (parts A and B). You can only get OTC benefits if you are enrolled in certain Medicaid and Medicare Advantage plans.
If you’re interested in having Medicare Advantage coverage with OTC benefits, you can shop around for participating plans during Medicare Open Enrollment. For Medicare coverage that starts on January 1, Open Enrollment begins on October 15 and ends on December 7 each year. You can enroll in Medicaid at any time if you are eligible.
