Does Medicare Cover an OTC Card?

Original Medicare (Part A and Part B) doesn't typically cover over-the-counter health products. Some privately sold Medicare Advantage (Part C) plans, however, may include OTC coverage.

In this review, we outline what Medicare Advantage OTC coverage may include, and we explore other options Medicare beneficiaries can consider when paying for health products.

OTC Benefits - Medicare Advantage Plans vs Medigap Plans

What is an OTC Card?

An OTC card is a benefit included with certain Medicare Advantage (Medicare Part C) plans that lets beneficiaries buy select over-the-counter products at participating locations.

It's important to note that Medicare OTC cards aren't available with all Medicare Advantage plans and may not be available in all areas.

Benefits of an OTC Card

There are many benefits to using your OTC network card, including:

• Convenience: Use a printed copy of your card to purchase necessary healthcare products.
• Savings: Take advantage of this benefit to reduce overall healthcare costs.
• Variety: Choose from a wide range of eligible over-the-counter products depending on your provider and plan coverage.

An OTC allowance is a great way to save money on essential health and wellness items that are not covered under traditional Medicare.

Who Qualifies for an OTC Card?

To get a Medicare Advantage OTC card, you must meet the requirements for Medicare coverage, which usually means being 65 or older and having worked for 10 years (or 40 quarters) while paying the Medicare tax.

You must also be enrolled in a Medicare Advantage plan that specifically includes an OTC card as one of its benefits or as an optional add-on to your plan.

• Age: You generally need to be at least 65 years old to qualify for Medicare.
• Work history: You must have worked and paid into the Medicare system through taxes for at least 10 years (or 40 quarters).
• Disability: Some people under 65 with qualifying disabilities can also enroll in Medicare.

What Products are Covered by an OTC Card?

Private Medicare Advantage plans that include OTC cards will likely each operate differently, with varying rules, costs, limitations and other things to consider.

Some OTC cards typically offer coverage for common items such as:

• Cold and cough medications
• Flu medication
• Antibiotic ointment
• Band-aids
• Denture-related products
• Digestive medications

Where Can I Use My OTC Card?

Many retailers accept OTC cards for eligible items, but check with your Medicare Advantage plan provider or visit their website to find participating locations.

Some common locations that may participate in Medicare Advantage plan OTC programs include:

• Walgreens
• CVS Pharmacy
• Walmart Pharmacy
• Target Pharmacy

FAQs

What does the OTC card not cover?

A Medicare plan with an OTC allowance typically does not cover prescription medications, alcohol, tobacco products, cosmetics or items for general household use.

Additionally, it usually cannot be used to purchase gift cards or pay for services such as doctor visits and lab tests.

What is covered under the OTC card?

Covered items may include over-the-counter medicines like pain relievers and allergy medication, first aid supplies, vitamins and supplements, dental care products, diabetic supplies, incontinence products and other health-related items.

Specific coverage may vary depending on your plan.

How often can I use my OTC card?

You can typically use a printed copy of your OTC card as often as needed until the available allowance is exhausted.

The funds are usually replenished quarterly by the insurance provider, but this frequency might differ based on individual plans. Check with your insurer for specific details about fund allocation schedules.

Do Medigap Plans Cover OTC Benefits?

Generally Medigap plans do not include over the counter benefits or a OTC card. But it is worth exploring Humana Medicare Supplement plans and other Medigap providers if you want coverage from out of pocket costs such as deductibles, copays and more.