Medicare Advantage OTC benefits: 5 ways to get the most out of these benefits

People might be asking if their Medicare Advantage plan includes an over-the-counter (OTC) benefit. And as it turns out, almost four out of five plans do — and if used it correctly, people can pay no additional cost for select OTC products.*

Even if people use the benefit only occasionally, they can still sharpen up their game. The benefit covers some essential OTC products — think cold medicine, toothpaste and pain relief support products. But it can also help people catch up on other wellness goals, like keeping a first aid kit up-to-date.

Read on for some simple strategies to help use the OTC benefit.

In this article:

OTC benefit basics

The OTC benefit — a common ingredient of Medicare Advantage plans — means funds to spend at retail pharmacies for eligible OTC products. It might come as an OTC card someone can use at participating retail stores. With this coverage, people receive a certain dollar allowance per year, per quarter or per month. (It varies by plan.)

People may be able to spend this allowance on a wide range of OTC items:

• Cough, cold and allergy
• Digestive health
• Eye and ear care
• First aid
• Foot care
• Oral and dental care
• Pain relief support
• Skin health
• Vitamins and supplements 

Why don’t people use their OTC benefits?

About 70 percent of Medicare Advantage patients who have an OTC benefit don’t use it. It’s possible that some people don’t use their OTC benefits because they don’t even know they have them — or if they do, they’re unsure how and when to use them.

To find out if someone has coverage, they should call the customer service number on the back of their Medicare Advantage card. The customer then should ask the rep if they have the OTC benefit, how much they can spend and how often the benefit resets. Knowing those three things will help people maximize their OTC benefit allowance, if eligible.

Tips for using a Medicare Advantage OTC benefit

With a little planning, people can make sure they always use their Medicare Advantage OTC benefits before they run out. Here are some tips to keep in mind:

1. Read the fine print

OTC product categories are typically similar across different Medicare Advantage plans. But specific items that qualify can vary. For example, a person’s plan may cover earplugs but not earmuffs.

In addition, some carriers might limit the number of orders people can place during each benefit term — for example, people may be limited to one OTC order per month.

A person’s plan should have clear information to share with them, whether online or by mail. But if someone is confused about any details, such as the amount they have to spend, what they can spend it on or how it all works, speak up.

“I tell people all the time to call their company and see if they cover it,” says Adria Goldman Gross, CEO of MedWise Insurance Advocacy. In other words, don’t be afraid to ask questions.

2. Plan ahead

Only some plans permit users to roll over their OTC benefit allowance for a limited time. These dollar amounts don’t roll over indefinitely. If someone doesn’t use their allowance before it expires — either monthly, quarterly or yearly — it’s gone.

“If someone uses a certain OTC medication regularly, they may consider using their benefits to stay supplied before the next policy begins,” Gross advises. “When I see any of my OTC medications running low, I always hit the drugstore ASAP.”

While someone’s health needs may change over the course of the year, some supplies will always come in handy. Think of cough and cold supplies in the winter, allergy relief support in the spring and so on. Or oral and dental care products, which might be in demand year-round. People should make a list of these staples so that their shelves will always be well stocked.

3. Ask a health care provider for suggestions

A health care provider knows their patient’s health well. So, it makes sense for people to let them know they have the Medicare Advantage OTC benefit. From there, health care providers can recommend any products to help manage their patients’ conditions or maintain their overall wellness. In fact, OTC products can be used to support a number of chronic conditions.

4. Set reminders

At the beginning of every year, people should consider marking their calendar so that they know when their OTC benefit resets. It can be especially helpful to set a date two weeks before the expiration date, to give folks enough time to shop for health and wellness essentials.

People can set reminders in a few ways:

• Add phone calendar reminders (or get someone to help set it)
• Leave a sticky note on a desk or fridge
• Mark important dates on a paper calendar
• Set a recurring reminder in a digital calendar

5. Select items wisely

A plan benefit may offer numerous ways to redeem eligible items. With CVS, people can use the benefit in participating stores.

If the way someone is using the benefit doesn’t fit their lifestyle, they just won’t use it. So, it’s important people consider their daily lifestyle and shopping frequency. It might take a few cycles to recognize what the easiest game plan is for them. But once it's a habit, they'll remember to use their available OTC benefit allowance to redeem eligible products.