People face a lot of medical expenses throughout their life; one of the most common is over-the-counter drugs. When you’re retired, on a fixed income, and on Medicare, you’ll want to know if Medicare covers over-the-counter medications. Read on to learn more.
Does Medicare Cover Over-the-Counter (OTC) Medications?
Original Medicare does not cover over-the-counter (OTC) medications. However, Medicare did not include any medication coverage upon its establishment.
Original Medicare (Part A and Part B) generally does not cover over-the-counter medications or prescriptions. Medicare Part D is an optional benefit offered to individuals with Medicare. It provides prescription drug coverage but does not usually cover OTC medication.
Does Medicare Part A Cover Drugs?
Medicare Part A is part of Original Medicare. It covers expenses in hospitals, skilled nursing facilities or homes, hospice care, and some home health care. Medications — both prescription and OTC — are not included in this coverage. The exception is that Part A will cover the drugs needed during a covered hospital or skilled nursing facility stay.
Does Medicare Part B Cover Drugs?
Medicare Part B is the second half of the Original Medicare. It helps cover medically necessary and preventive services such as doctor visits, outpatient care, home health services, mental health services, durable medical equipment, lab tests, and other medical services. A limited number of outpatient prescriptions are included, such as chemotherapy, but there is no coverage for OTC drugs.
Can Part D Plans Include Over-the-Counter Products (OTCs)?
Medicare Part D generally does not cover OTC drugs. Instead, Part D is an optional benefit offered by private companies that help cover the cost of certain prescription drugs. Each Part D plan covers a certain list of drugs called a formulary. Typically, these plans place covered drugs into tiers which have corresponding copayments or coinsurance. Generally, drugs in lower tiers have lower costs than drugs in higher tiers. By law, some drugs are excluded from Medicare coverage including drugs for weight loss and gain and OTC drugs.
In 2022, the average monthly cost of a Part D supplement plan costs about $445, or approximately $33 per month. However, the premium will vary based on the level of coverage you need. Note that if you have a higher income or enroll late, you may face additional premiums.
Which Drugs Are Not Covered by Medicare Part D?
Certain drugs are not covered by Medicare Part D. Commonly excluded drugs are:
- Hair growth medications
- Medications for cosmetic enhancement
- Treatment of a cold or cough
- Sexual dysfunction medications
- Fertility drugs
- Vitamins and minerals
- Weight gain or loss medications
Do Medicare Advantage Plans Pay for OTC Drugs?
If you want coverage for OTC drugs, consider Medicare Part C, also known as Medicare Advantage. Medicare Advantage bundles Medicare Part A, Part B, and usually Part D. These plans are offered by Medicare-approved private companies that must follow rules set by Medicare. Plans must cover all medically necessary services and supplies that Original Medicare covers, and most cover extra benefits that Medicare does not cover,m such as fitness programs; some vision, hearing, and dental services; and over-the-counter drug coverage.
What Can I Purchase with Medicare Advantage?
A recent study found that 80% of Medicare Advantage plans offer OTC allowances. Some common OTC medications covered are:
- Incontinent supplies
- Cold remedies
- Flu medications
- Antibiotic ointment
- Digestive aids
- Oral care and denture items
- First aid items
- Pain relievers
- Sleep aids
- Wart removal
- Orthopedic support
How the OTC Benefit Works
You must review the specific Medicare Advantage plan you’re interested in to see how OTC coverage is handled. Many Advantage programs have OTC benefits, but not all of them do, and there are differences in reimbursement procedures.
Reimbursement for OTC products can be handled in a number of ways. One common method is a prepaid card that can be reloaded each month or quarter and used at qualifying locations for OTC purchases. Once you hit your card limit, you’ll pay out of pocket.
Other Medicare Advantage plans give subscribers a list of approved OTC medications you can purchase at your pharmacy or online. The discounts are applied at the time of purchase, or you can send receipts to your insurance plan for reimbursement after the fact.