Medicare Advantage plans are known for offering additional benefits beyond what Original Medicare (Parts A and B) covers. One increasingly popular benefit is Over-the-Counter (OTC) benefits. But what exactly are they, and how do they work? This is Part I in our series on understanding and making the most of these benefits.

What are OTC benefits?

OTC benefits are a set allowance provided by many Medicare Advantage plans that can be used to purchase certain health-related over-the-counter products. Think of it as a pre-loaded spending account for items you likely already buy to manage your health.  

These benefits are designed to help Medicare Advantage members save money on everyday health and wellness needs. Instead of paying out-of-pocket for these items, you can use your OTC benefit allowance. This can include things like:

• Pain relievers
• Cold and flu remedies
• First-aid supplies
• Vitamins and supplements
• And much more!

It’s important to note that OTC benefits are not the same as your regular Medicare benefits. They are an additional benefit offered by private Medicare Advantage plans.

Evaluating benefits when choosing a plan:

When you’re comparing Medicare Advantage plans, OTC benefits can be a valuable factor to consider when making your decision. However, it’s not as simple as just looking for a plan that offers them. Here’s what to look for:

• Availability: Not all Medicare Advantage plans offer OTC benefits. Check the plan’s summary of benefits to see if they’re included.
• Allowance Amount: The amount of your OTC benefit can vary significantly from plan to plan. Some plans may offer a small monthly allowance, while others may provide a larger amount less frequently (e.g., quarterly).  
• Usage Restrictions: Some plans may restrict where you can use your OTC benefits. For example, you might be limited to using them at specific participating pharmacies or through a mail-order catalog. Others may provide an OTC card that can be used at a wider range of retailers.
• Consider the Big Picture: While OTC benefits are a nice benefit, don’t let them be the only factor in your decision. Always compare the plan’s premiums, deductibles, copayments, networks, and other coverage details to ensure it meets your overall healthcare needs.  

By carefully evaluating the OTC benefits offered by different Medicare Advantage plans, you can choose a plan that not only provides comprehensive healthcare coverage but also helps you save money on everyday health and wellness expenses.

Using Your OTC Benefits: A Practical Guide

So, you’ve chosen a Medicare Advantage plan that includes OTC benefits – great! Now, let’s dive into the specifics of how to use them effectively.

How to access your OTC benefits:

The way you access your OTC benefits will depend on your specific Medicare Advantage plan. Here are some common methods:

• OTC Cards: Many plans provide members with a pre-loaded debit card specifically for OTC purchases. These cards often have a set amount of money added to them periodically (e.g., monthly or quarterly). To use the card, simply present it at checkout when purchasing eligible items at participating retailers.
• Mail-Order Catalogs: Some plans partner with specific vendors that offer OTC products through mail-order catalogs. You can browse the catalog, select the items you need, and place an order online or by phone. Your OTC benefit will be applied to the purchase.
• Participating Retail Locations: Your plan may have a network of participating pharmacies or retail stores where you can use your OTC benefits. When shopping at these locations, you can typically use your OTC card or provide your plan information to access your benefit.

What can you buy with OTC benefits?

The specific items you can purchase with your OTC benefits will vary depending on your plan. However, most plans generally cover a range of health-related products, such as:

• Pain relievers: Acetaminophen, ibuprofen, and other common pain relief medications.
• Cold and flu remedies: Cough drops, nasal sprays, and other products to alleviate cold and flu symptoms.
• First-aid supplies: Bandages, antiseptic wipes, and other items for minor cuts and injuries.
• Vitamins and supplements: Various vitamins, minerals, and dietary supplements.
• Other health-related items: This may include things like:
  • Eye drops
  • Denture care products
  • Incontinence supplies
  • Support braces

It’s crucial to check your plan’s list of eligible items to ensure that what you want to buy is covered. There will be restrictions; for example, you can’t typically purchase things like:

• Prescription medications
• Cosmetics
• Food items (unless specifically allowed)

Important rules and tips for using your OTC benefits

To make the most of your OTC benefits, keep these points in mind:

• Expiration Dates: Your OTC benefits will typically have expiration dates. If you don’t use them within the allotted time, you’ll lose them. Pay attention to when your benefits expire to avoid missing out.
• Renewal Periods: OTC benefits are usually replenished on a regular schedule (e.g., monthly or quarterly). Know when your benefits will be renewed so you can plan your purchases.
• No Carryover: In most cases, unused OTC benefits do not carry over to the next period. So, it’s generally best to use them consistently throughout the year.
• Avoid Fraud: Be cautious of any offers or promotions that seem too good to be true. Do not give out your personal information to unauthorized individuals or use your OTC benefits for anything other than eligible purchases.

By following these guidelines, you can effectively use your Medicare Advantage OTC benefits to save money and improve your health and well-being.