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What does Medicare Advantage cover? For one, CVS® drugstore visits.

The OTC benefit from Medicare Advantage may be the most useful — and most overlooked — value for older adults.

Published: February 26, 2024 |9 minute read

Written by: Jessica Sebor

Mature man smiling as he discusses over-the-counter products with a CVS store attendant.

Reaching retirement age means you’ve earned a few perks. Movie tickets should cost a few dollars less. Your favorite restaurant might give you a break.1 And you ought to get a helping hand with some out-of-pocket costs that keep you healthy.

The good news is that many Medicare Advantage members get help paying for over-the-counter (OTC) products. The OTC benefit is included in most Medicare Advantage plans,2 and it can be used to buy hundreds of eligible OTC items — toothpaste, vitamins, cough syrup and much more.

“Using your Medicare Advantage OTC benefit is crucial,” says Caitlin Donovan, senior director at the National Patient Advocate Foundation.3 “It’s your money, and you should be able to use it.”4

So what exactly is the Medicare Advantage OTC benefit — and how can you take advantage of it? Read on for everything you need to know.

In this article:

What is the OTC benefit?

Medicare Advantage OTC benefits are offered by most Medicare Advantage plans. The benefit is an allowance to purchase certain OTC items you’d get at a drugstore.5

It works a little like a health savings account (HSA), the popular tax-advantaged account that lets you pay for many personal health care costs. But unlike an HSA, you don’t need to put your own money into an OTC allowance.6 Instead, it’s money your Medicare Advantage plan gives you to cover eligible OTC items that help keep you healthy.7

While most Medicare Advantage plans have an OTC benefit, keep in mind that the specifics come down to your individual program and provider. Some key differences can vary from plan to plan:

  • Budget. The average plan offers $100 per quarter, but the amount can be more or less.8
  • Where you can shop. Many plans allow you to shop in-store at CVS, using your Medicare Advantage OTC card.
  • What you can buy. You can typically buy common drugstore items like aspirin, vitamins, toothpaste and antihistamines with your Medicare Advantage OTC benefits. But some plans can extend to things like dental cleanings, healthy food and even utility bills.9
  • How often your card refills. Your card may refill at different times during the year — quarterly or monthly — or once annually. Or the date may not be fixed at all, but your card fills up based on your behavior, getting loaded up as you take advantage of more preventive benefits.10

To understand and make full use of your Medicare Advantage OTC benefits, it’s important to contact your insurance provider for all the details about how the plan works.

How do I know if I have the OTC benefit?

If you have a Medicare Advantage or a Medicaid plan, chances are good that you do have an OTC benefit.11 But the best way to know is to ask.

You can call the customer service number on the back of your Medicare Advantage card to find out whether it’s included. That number will also get you information about how to use the benefit and exactly what yours covers.

Do most people use their OTC benefit?

It’s a great benefit — free money for products that most people use every day. But does it actually get used? The response has been mixed.

The majority of people don’t use it enough, according to a report from the Consumer Healthcare Products Association.12 While members can be excited about this benefit initially, only 20 to 35 percent of people enrolled actually take advantage of it once a year or more.13

What if I don’t spend my OTC benefit?

If you don’t spend your allowance, you might be leaving free money on the table. Depending on your plan, if you don’t use your benefit, it may expire at the end of the month, the end of the quarter or the end of the year.

That means the Medicare Advantage OTC benefit has a “use it or lose it” agreement and can’t be carried over.14

What can I use my OTC benefit for?

The items covered by your benefit will vary from plan to plan. To understand exactly which OTC products you can get, reach out to your insurance provider.

There are some shortcuts. CVS stores make it easier with “OTC Eligible” blue tags. While this might not extend to every plan, these tags flag the types of products that are widely covered.

Products often covered can include:

  • Adult care (overnight underwear, cleansing wipes, bladder control pads)
  • Allergy medicine
  • Cold and flu medication
  • Digestive health (fiber, antacids, stool softener, gas relief support)
  • Ear and eye care (eye drops, contact solution, ear wax removers)
  • First aid (antibiotic ointment, bandages, face masks)
  • Foot care (antifungal creams, corn removers, compression socks)
  • Home diagnostics (COVID-19 tests, blood pressure monitors)
  • Home health care (bath mats, canes, shower chairs)
  • Nicotine replacement and smoking cessation support
  • Oral care (toothpaste, toothbrushes, denture cleaner)
  • Pain relievers (ibuprofen, aspirin, muscle rubs)
  • Personal care (sunscreen, face wash, hand sanitizer)
  • Vitamins and minerals15
  • Women’s health (maxi pads, yeast infection creams)

Can I use my OTC card for anything at the pharmacy?

Your OTC benefits card can only be used on items that are covered by your specific Medicare Advantage or Medicaid plan. Generally, this won’t include things like holiday decor, pet care and beauty — in other words, purchases that don’t contribute directly to your health.16

There will also be limits on the participating brands and products. And there may be limits to how much of one item you can buy during any one period. Again, check with your plan for details.

How do I use my benefit?

Your Medicare Advantage plan may offer the option to shop through CVS. If so, you can use it in-store on eligible products. A separate article explains exactly how to use the OTC benefit with CVS.

Just visit a participating CVS store, then select the OTC products you want to buy. (Blue tags signal broad OTC eligibility.) Some insurance providers will send you a benefits card, which you can use as you would a debit or credit card.

Is it easy to use my OTC card?

By and large, using your benefit should be fairly straightforward. You can use the benefit multiple times as long as the money hasn’t run out.17 If you buy something that goes over your allowance, you can pay the rest out of pocket.18

At CVS, you can ask for assistance from an in-store professional. Remember: The trickiest part may be remembering that you have the benefit and need to make the most of it. It might be helpful to set a digital reminder on your phone — or even leave a note on the refrigerator. “People shouldn’t be afraid to use the benefit,” Donovan says.19

Can a caregiver use my OTC card?

In most cases, yes, a caregiver can use an OTC card. They’ll follow the same process of shopping for items. Then at the checkout, they will generally need the Medicaid or Medicare Advantage member’s OTC benefit card and/or plan information. The sales associate may sometimes ask for another form of ID from the member.

You can read more information on how the OTC benefit can support caregivers, including tips on shopping for people over 65.

Any tips for using the OTC card in a smart way?

You’ll want to make sure you use every dollar of your benefit before it expires. But beyond that, experts say there are a few considerations to help stretch those dollars.

Before you purchase an OTC medication, Donovan suggests making sure there isn’t a prescription alternative that might be covered completely by your plan.20 “Also think about your own budget and when you might need the extra assistance,” she says. And it’s important to talk to your doctor before taking any sort of vitamin, supplement or new OTC medication.

And make a seasonal purchase plan, where you map out what you’ll buy all year and when you’ll place those orders. That can ensure you get every bit of a benefit that’s meant to help you stay healthy and keep expenses down.

CVS® makes it easy to redeem OTC benefits

You may be eligible to get select over-the-counter (OTC) products at no additional cost.*

Learn more about OTC benefits

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.