What Are OTC Benefits in a Medicare Advantage Plan?

Have you ever heard that Medicare Advantage plans often offer benefits beyond what's covered by Original Medicare? It's true! Medicare Advantage plans have become a popular option for Medicare enrollment among Medicare beneficiaries. Among other things, one added benefit that has become increasingly common is known as the Over-the-Counter (OTC) benefit. In this article, we'll highlight what exactly this benefit is and how you can sign up for a plan with this type of coverage.

What Are OTC Benefits?

Over-the-Counter (OTC) benefits are not covered by Original Medicare but are a popular additional benefit included with many, but not all, Medicare Advantage plans (MA/MAPDs). In short, the perk provides some allowance towards non-Medicare-covered over-the-counter items you obtain from a pharmacy. The way the OTC benefit works and the OTC allowance available can vary from plan to plan.

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Why OTC Benefits Matter

Over-the-Counter (OTC) benefits are a valuable perk included in many Medicare Advantage plans. For many seniors on a fixed income, and with inflation at all-time highs, OTC benefits can help provide cost savings on everyday health items they would be purchasing regularly. These benefits also offer added convenience, as products can often be shipped directly to your home.

What Can You Buy With OTC Benefits?

There are often thousands of items available for purchase using the funds or allowance provided with Over-the-Counter (OTC) benefits.

Some common items covered by OTC benefits include:

Pain relievers (ibuprofen, acetaminophen, topical pain creams)

Cold, flu & allergy remedies (liquids, tablets, capsules, cough drops)

Digestive health aids (antacids, fiber supplements)

Eye & ear care (artificial tears, ear drops, contact lens solutions)

First-aid supplies (bandages, topical antibiotics)

Oral hygiene (toothpaste, toothbrushes, floss)

Vitamins & dietary supplements (multivitamins, calcium, joint support)

Foot care (antifungal creams, foot pain relievers)

Skin care (moisturizers, sunscreens, acne treatments, barrier creams)

Smoking cessation products (nicotine gum, patches, lozenges)

Health support items (compression socks, joint braces, electric heating pads)

Incontinence supplies (disposable underwear & underpads)

Sun protection (sunscreens of all SPFs)

Items That Are Typically Not Included:

Cosmetics and beauty products (makeup, anti-aging creams, teeth whiteners)

General personal care items (shampoo, deodorant, soap, toilet paper)

Food and beverages (unless you're in a plan with a specific grocery allowance)

Herbal and homeopathic remedies (unless specifically listed by the plan)

How Do You Use Your OTC Allowance?

Generally, there are a few ways to use your over-the-counter allowance, but check with your plan because these methods do vary. Methods typically include purchasing in-store at participating pharmacies, ordering online, or using a catalog and calling in your order by phone.

As we've already established, extra perks for Medicare Advantage plans, including OTC benefits, vary, and the allowance amount and frequency of these are no exception. Most plans will have a designated amount for OTC benefits available each month or on a quarterly basis. Often, the allowance, if not used, does not roll over and is lost, so to get the most from this benefit, it's best to make sure you use your allowance so you don't lose out on this perk. Additionally, be sure to understand your plan's ordering requirements because some plans only allow a single order per benefit period, so it's important to plan your purchases accordingly.

Who Qualifies for OTC Benefits?

Over-the-counter benefits are available to medicare recipients who enroll in a qualifying Medicare Advantage plan that includes this type of benefit.

How to Find a Plan That Offers OTC Coverage

If you are interested in signing up for a Medicare plan that gets you more than you have now, working with a professional like the team of Medicare brokers at Twin City Underwriters can help you make an informed decision. It's essential to note that signing up for a Medicare plan solely for the OTC benefit or other added perks is not advisable. 

Our team is dedicated to ensuring that every facet of your Medicare plan is tailored to meet your unique needs. So often we hear of individuals who signed up for a plan for dental coverage only to discover one of their specialists was not in-network or an important medication was not covered. It's essential to look at the whole picture before signing up for a plan.

Reach out to our team today for unbiased recommendations and support choosing a Medicare plan that works for you. 

Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, UCare, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.