Enrolling in a Medicare Advantage Plan is a great choice if you want comprehensive healthcare. Most Medicare Advantage plans offer prescription help. They also include enhanced benefits such as coverage for dental care, eye exams, and hearing aids. Did you know that some plans also offer an allowance toward common over-the-counter necessities? 

These OTC benefits cover a wide range of most likely purchased monthly items and include much more than just over-the-counter medications. The over-the-counter allowance provided exclusively by Medicare Advantage plans is separate from Medicare’s Part D Prescription Drug coverage program. 

How OTC Benefits Differ from Prescription Drug Coverage

Medicare Advantage plans that provide an allowance for OTC medications aren’t considered prescription assistance programs. This is because the products covered are not prescribed by a physician or healthcare provider. Medicare Advantage Plan OTC benefits don’t lower prescription drug prices, nor can the allowance be used towards Medicare copay. 

If you have Original Medicare or Medicare Part D, over-the-counter benefits are not provided through these plans even though many of the items are healthcare-related. This includes items such as:

  • Cold or cough medications
  • Denture adhesive and dental sanitizers
  • Vitamins and minerals
  • Eye care solutions
  • Weight gain or weight loss supplements
  • Medications used for hair growth or other cosmetic purposes

For Medicare beneficiaries who live on a fixed income, having an OTC allowance for items that you regularly purchase is a substantial benefit. It helps to free up money for other monthly expenses like Medicare copays, life insurance, rent, or mortgage payments. An over-the-counter plan allowance is one of the best money-saving benefits provided by Medicare Advantage.

As an example, good quality batteries are usually expensive. Especially if you wear a hearing aid that requires specific batteries that are unique in size and shape. Many Medicare Advantage plans with OTC benefits cover batteries for hearing aids. By purchasing hearing aid batteries through your plan’s OTC catalog or website, you’ll have money left over for other important expenses. 

Just think about how much extra cash you would have left in your monthly budget if you didn’t have to pay for routine personal items, including things like bathroom tissues, vitamins, and bandages? Additional personal care items covered by some OTC plans include:

  • Compression hosiery
  • Absorbent undergarments
  • Nicotine patches and gum
  • Knee braces and canes
  • A bathroom scale or thermometer
  • Sunscreen and sunblock items
  • Toothbrushes and toothpaste

Hand Sanitizer and disposable face masks are also covered under many OTC plans. These extra expenses add up quickly. Not having to pay for these items during the pandemic would free up more discretionary income for healthy organic foods and health-related activities. 

How to Use OTC Benefits

Medicare Advantage Plans come with various combinations of enhanced benefits, ranging from $10 – $150 per month for OTC expenses. Start by checking your Medicare Advantage Plan’s summary of benefits to confirm the monthly or quarterly dollar amount of your OTC benefit. 

Benefits Provided with an OTC Card

Some plans disburse these benefits via an OTC swipe card that is refilled every month. You can use this OTC card to purchase only the plan items at a retail pharmacy or store. These items will have a discounted price that has been negotiated through your plan’s provider. Your Medicare Advantage plan provider should offer you a list of local retail locations where you can use your OTC benefits card.

Catalog or Website OTC Purchases

Several plans require you to purchase items through an Over-the-Counter catalog that’s mailed to you. The catalog is usually part of your Medicare Advantage Plan welcome packet. Still, other plans require you to order your OTC items through a website. 

How to Place an Order

The fastest and easiest way to order is online through the provider’s website. To do so, create an account that includes your member ID, date of birth, and current email address.

When choosing from the list of items provided by your plan, there is a discounted price for each item listed on the website or in the catalog. If you order through your account, the system will keep track of your purchases to make sure that you don’t exceed your monthly allowance using the discounted pricing.

You can also place a catalog order through a phone number provided in your catalog. When you order online or through a catalog phone number, your items will be shipped to the address registered for you on your Medicare Advantage Plan.

It’s important to remember that your OTC allowance does not roll forward. If you don’t use the dollar amount in the specified period, you lose it for that period. 

Are OTC Benefits the Same as Medicare’s Extra Help Plan?

Medicare Advantage OTC benefits are bundled services provided by the private insurance companies that manage your Medicare Advantage Plan. This is not the same as Medicare’s Extra Help plan.

Medicare’s Extra Help Plan is a supplemental program provided by Medicare that covers monthly premiums, annual deductibles, and prescription co-payments not covered by Medicare Part D.

To qualify for the Extra Help plan, your total resources and income must fall below a certain threshold. For 2021 – your resources must be below $14,790 for singles and $29,520 for a married couple. You must be enrolled in Medicare Part D to apply. 

The Takeaway

Medicare Advantage plans bundle enhanced healthcare options to provide Medicare recipients with low-cost comprehensive healthcare. 

Advantage Plans that offer a monthly Over-the-Counter (OTC) allowance to cover the cost of items that members routinely purchase are a substantial money-saving benefit. Most plans cover more than just OTC medications and include personal care items like toothpaste and denture glue, bathroom scales and knee braces.

If you are a Medicare recipient and are shopping Medicare Advantage plans, review the range of OTC benefit options available in your area through Medicare Advantage.