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What Is a Medicare OTC Card?

Over-the-counter drugs (OTCs) are medications one can purchase from a pharmacy or drug store without a prescription. However, if you must take these drugs frequently, they can become quite costly. Some Types of Medicare plans offer a special card that can cover OTCs and more. Read on to learn what a Medicare OTC card is, who qualifies for an OTC card, and how to get one.

What is a Medicare Advantage OTC Card, and How Does it Work?

A Medicare Advantage OTC card functions much like a debit or credit card. When you purchase a covered item at a participating retailer, the price is deducted from your OTC card balance. If there is not enough on the card to cover the full price of your purchase, you pay the remaining amount out of pocket.

Depending on your provider, OTC cards may be filled each quarter (every three months) or at the beginning of every month. Funds on OTC cards do not carry over to the next month or quarter. If you do not use your full quarterly allowance, any unused funds are lost.

Some OTC cards work in preferred pharmacies, or only allow you to get specific items. Always check or ask if the OTC products you are looking for are part of the OTC catalog for the Medicare Advantage plan you’re selecting. Never assume anything about what you can use your OTC card on. Always ask your customer service representative or your agent about how or where you can use your OTC card.

Eligibility

You may be eligible for a Medicare Advantage OTC card if you are currently enrolled in a Medicare Advantage plan and if that plan offers OTC cards. Providers are not obligated to offer OTC cards, and different plans may offer different levels of coverage for OTC purchases. Original Medicare does not offer an OTC card option. 

Common Items Covered By the Medicare Advantage OTC Card

Each insurance provider has a list of items covered by their Medicare Advantage OTC card. Common products covered include OTC drugs and medical products, such as:

  • Cough and cold medications
  • Antibiotic ointments
  • Pain relief medications
  • Band-Aids
  • Orthopedic support devices
  • First aid materials such as bandages or gauze

Common Exclusions

Items not used for medical purposes may be excluded from OTC card coverage. Some examples include:

  • Toothpaste
  • Deodorant
  • Insect repellant
  • Face creams or lotions
  • Cosmetics
  • Diapers

How to Use Your OTC Medicare Card

Once you have your OTC card, you can use it at participating stores. Here’s what that looks like in practice. 

1. Verify your OTC card balance and eligible items: First, check your balance to see how much money you have available for OTC purchases. Then, check your provider’s list of eligible and ineligible items to see what you can purchase with your OTC card and what is not covered. 

2. Find a participating retailer or pharmacy: Next, find stores that accept your OTC card. Stores do not have to take these cards and do not have to take cards from every insurance company. Popular stores that may take OTC cards include CVS, Walgreens, and Walmart, but it’s worth checking online to see if your insurance provider has a list of participating stores. You can also call the store directly and ask if they accept OTC cards. It’s better to know before you go than to discover your card is not accepted when you get to the checkout.

3. Select your OTC items: Once you have confirmed your balance and made sure the store accepts your card, it’s time to start shopping. Select your OTC items and put them in your cart, but keep them separated from non-OTC products to make checking out easier. 

4. Proceed to the checkout and present your card: When ready, head to the checkout and present your card along with your covered items. The total amount is deducted from your card balance. If you do not have enough money on the card to cover the entire purchase price, you pay the difference out of pocket. 

5. Confirm the transaction: Once the transaction is complete, get a receipt and confirm that your OTC card covers the purchased items. 

6. Keep track of your purchases and OTC card balance: Keep the receipt for your records, and regularly check your OTC balance to make sure that the amount you spent is the amount deducted from your card. 

Many beneficiaries forget to use the OTC card portion of their plan, or even know much about it. But depending on the plan, you may have $60 per quarter you are able to spend on other items that are not prescription related.

Checking Your OTC Card Balance

Depending on your provider, you may be able to check your card balance online or over the phone through an app. If checking your balance online, head to your insurance provider’s website. You may need to create an online account with your provider if you do not have one. Once you’ve logged in, enter your card details to check your balance. You can also call the number on the back of your card to check your balance over the phone.

Managing Your Card

Here are a couple of the most common issues that need to be managed with Medicare Advantage OTC cards:

  • Activating your card: When your card arrives in the mail, follow the provided instructions to activate it. Some providers ask you to activate by phone, while others let you do this online.
  • Replacing a lost or stolen card: To replace a lost or stolen card, first report it to your insurer. They can then cancel the current card and send you a replacement.
  • Updating your personal information: If you move, change your name, get a new phone number, or have other personal information changes, it’s a good idea to update your card details. Some providers allow you to do this via online portals, while others may ask you to call and speak to an agent directly. 

How to Get a Medicare Advantage OTC Card

  1. Compare the Medicare Advantage plans available in your area that offer an OTC card benefit. First, look at your card options. It’s worth comparing multiple Medicare Advantage plans in your area to see what OTC benefits they offer, such as the amount put on your card each month or quarter and what the OTC card covers. Given the sheer number of Medicare Advantage plans available, contacting an insurance agent to help narrow the field may be helpful.
  2. Select your preferred plan. Choose the plan that works for you. Factors to consider include the total amount of coverage offered, how often the card is refilled, what the card covers, and any other plan benefits in addition to the card. 
  3. Wait for the next applicable enrollment period and apply to enroll. Enrollment in Medicare Advantage plans happens during specific periods, including:
    • Annual Enrollment Period: October 15 – December 7 each year. During this period, you can join, drop, or switch to another Medicare Advantage plan or from Original Medicare to a Medicare Advantage plan.
    • Open Enrollment Period: January 1 – March 31 each year. If you are enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan during this period. 
    • Special Enrollment Period: Dependent on life circumstances. For example, if you move to a new address, get Medicaid, or lose your current coverage, you may be eligible for a special enrollment period. During this period, you can join a new plan or switch to another plan. 
  4. Receive confirmation of enrollment and your OTC card. Once you have applied for your OTC card, you should receive confirmation via email or regular mail that your enrollment is confirmed. When your card arrives, follow the instructions to activate it. Depending on when you receive the card, you may need to wait until the next refill period starts to begin using it. 

Putting It All Together

OTC cards are a benefit of Medicare Advantage plans that help streamline the process of buying over-the-counter medications and products for cardholders. Card balances are refilled on a set schedule, and policyholders can use their cards to pay for items covered by their insurance company at participating retailers. 

While OTC cards on their own may not be enough to convince you to switch Medicare Advantage plans or move from Original Medicare, they can help make Medicare Advantage plans more appealing. 

Frequently Asked Questions

To find out if your Medicare Advantage plan offers an OTC card, first review your plan materials, including the Annual Notice of Change and Evidence of Coverage. You can also contact your insurance provider’s customer service, visit their website, or attend information sessions if available. Your pharmacist may also have information, and checking your plan’s member portal is another option to access OTC benefit details.

Yes, but the balance is deducted from your card. However, the primary intent of the OTC card for the cardholder’s use, not for others.

If you don’t use all of your OTC (Over-the-Counter) allowance in a given quarter or year under your Medicare Advantage plan, the unused funds typically do not roll over or accumulate. The allowance is usually reset at the beginning of the next quarter or year, and you are provided with a new allowance for that period. It’s important to check your plan’s specific guidelines, as the rules can vary between different Medicare Advantage plans.

Some stores accept returns of unopened items and can refund the balance to your OTC card. Others may accept an exchange, and some do not allow returns or exchanges. Before purchasing an item on your OTC card, confirm the store policy. 

No. Your OTC card cannot be used to cover prescriptions, prescription copayments, or deductibles. It can only be used for OTC items covered by your provider.

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