What caregivers may need to know about the drugstore Medicare Advantage benefit

Serving as someone’s caregiver can be rewarding, but it can also be stressful. Unexpected costs can be a part of that stress. If someone’s loved one has a Medicare Advantage plan, however, help may be on the way. The Medicare Advantage over-the-counter (OTC) benefit may pay for hundreds of dollars of useful OTC products, including personal hygiene items, supplements and pain relief support medications.

The benefit from many plans can be used at participating CVS stores. Learn more below about the details.

In this article:

What is the Medicare Advantage OTC benefit? 

In 2021, about 80 percent of Medicare Advantage plans include the OTC benefit. It provides eligible members with an allowance to pay for certain products found at the drugstore — products that can help people stay well or move through an illness. Hundreds of OTC items are on the approved lists, including toothpaste, pain relief support medications, cough, cold and flu medicines and much more. Members can use this benefit at CVS stores.

Each health plan’s OTC benefit is a little different, so it’s important to look at the specific plan. But they may allow up to $400 in expenses each year. Note that in many plans, unspent allowance does not carry over to the next quarter, so people must “use it or lose it.”

Most people who have this valuable benefit aren’t aware or don’t take advantage of it. About 70 percent of the available OTC benefits go unspent each year in the U.S.

How can a caregiver use the OTC benefit on behalf of the member?

Using the OTC benefit is easy. In many cases, plan providers issue a card that a member or caregiver can use at participating stores. Purchase eligible OTC products at the checkout. People should check with their Medicare Advantage plan for any limitations on where they can use the card and what items they can use it for.

At participating CVS stores, caregivers may use this benefit on behalf of the member with the member’s permission. The caregiver may be asked to provide the member’s health plan card or their name and date of birth at checkout. The cashier may ask for additional identification to verify eligibility.

How can people get the most out of their benefits?

People should check their health plan’s website for guidelines on covered products. Then they can make a list of the various eligible OTC products that the member needs every day — and ask the member for any items they may have missed, such as hygiene or personal care products.

Keep in mind that most OTC benefit plans cover the costs of much more than items for restocking the medicine chest. For instance, people can make visits to the bathroom safer with grab bars, a rubber bathmat and a shower chair, as well as a raised toilet seat — all items that may be included in provider plans. Walking canes and walkers, blood pressure monitors and COVID-19 tests may also be included.

People can learn about using their OTC benefits with a month-by-month plan and by following planning ahead and thoughtfully selecting their items.

Special considerations when shopping for people as they age

It’s important to bear in mind that seniors often have unique and changing needs when it comes to OTC products.

Remember to consult with a health provider before starting or stopping any supplements or OTC medications as they may interact with prescription medications.