Guide to Obtaining a Medicare Over-the-Counter Card

Obtaining a Medicare Over-the-Counter (OTC) Card Guide

Medicare, a federal health insurance program for individuals aged 65 and above, has expanded its coverage to include Over-the-Counter (OTC) medications for those enrolled in Medicare Advantage plans. Here's a breakdown of what you need to know about Medicare OTC benefits.

Firstly, it's important to note that Medicare prescription drug cards were introduced in 2004 and apply to years starting from 2004 onward. To receive a Medicare OTC card, a person must be enrolled in a Medicare Advantage plan that offers OTC benefits.

Most Medicare Advantage plans provide some level of coverage for OTC medications, although the specifics may vary. Roughly 88% of people enrolled in Medicare Advantage plans in 2024 had OTC benefits.

The use of an OTC card, which functions as a debit card, may be subject to spending limits and the expiration of funds, and these details can vary based on the plan. It's recommended that individuals check their Evidence of Coverage (EOC) documentation or contact a plan representative to learn the specifics of their OTC card's use.

The frequency at which a plan adds funds to an OTC card also varies based on the plan. It's best to review your plan details to stay informed.

The labeling systems for eligible OTC products vary across retailers, so it's essential to familiarise yourself with these systems to make the most of your OTC card.

To find a plan that includes a Medicare OTC benefits card, you can use Medicare's plan finder tool. To use this tool, enter your ZIP code, select "Medicare Advantage Plan (Part C)", answer questions about cost assistance and drug preferences, and select a desired plan. To see "Over the counter drug benefits" in the plan finder tool, expand the box at the bottom of the "Extra Benefits" tab.

It's worth noting that not all Medicare enrollees receive OTC benefits; a person must be enrolled in a Medicare Advantage plan that includes this coverage to receive an OTC card.

Original Medicare and Medicare Advantage are two types of Medicare coverage. While Original Medicare primarily covers hospital and medical expenses, Medicare Advantage offers additional benefits like vision, dental, and hearing care.

Certain individuals under 65 years may be eligible for Medicare OTC benefits if they have a qualifying disability, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

If you have an OTC card, it's beneficial to review plan details to learn whether your plan allows funds to roll over into new benefit periods. Not all plans allow this, so it's essential to check your plan details.

OTC cards can be used to purchase a variety of health and wellness products, such as dietary supplements, cold medication, dental care supplies, first aid products, allergy medication, pain relievers, and more.

Lastly, if you have any questions about your OTC benefits, don't hesitate to contact your plan by phone. A representative will be happy to explain the details of your coverage.