When we think of Medicare, we typically think of the federal health insurance program for qualifying individuals. People over 65, people with End-Stage Renal Disease, and some younger people with disabilities generally qualify for Medicare. The three main parts of Medicare include:
- Medicare Part A (Hospital Insurance)
- Medicare Part B (Medical Insurance)
- Medicare Part D (Prescription Drug Coverage)
Medicare Part A and Part B are referred to as Original Medicare. Some people are automatically signed up for Original Medicare; others must apply online at Social Security. Medicare Part D is also used online through Social Security.
There is also Medicare Part C, commonly referred to as Medicare Advantage. Medicare Advantage plans are Medicare-approved plans offered through a private insurance company that provides an alternative option to Original Medicare. Medicare Advantage plans typically bundle Medicare Part A and Part B, with many including Part D. Medicare Advantage plans are required to cover everything Medicare Part A and Part B cover. These private plans tend to provide extended benefits not offered through Original Medicare, like vision, dental, and hearing coverage.
Does Medicare Cover OTC Healthcare Costs?
Neither Medicare Part A nor Part B covers over-the-counter (OTC) drugs and healthcare products. Only Medicare Advantage plans cover these types of costs through a Medicare OTC card.
What Are Medicare OTC Cards?
The private insurance companies that offer Medicare Advantage plans offer Medicare OTC cards. In addition to frequently covering extended benefits not covered by Original Medicare, like vision and dental coverage, many Medicare Advantage plans also offer a Medicare OTC card that covers qualifying over-the-counter drug and healthcare costs. However, the level of coverage for OTC costs varies depending on the insurance carrier.
What Do Medicare OTC Cards Cover?
The costs and guidelines for Medicare OTC cards depend on your chosen plan. Plans are often set up to cover a certain amount of monthly OTC costs. For example, your plan might cover up to $120 monthly for qualifying OTC costs, with a maximum annual cap of $1,440.
Some OTC drug and health items Medicare OTC cards might cover include:
- Antibiotic ointment
- Band-aids
- Cold and flu medications
- Denture-related products
- Digestive aids
- First-aid supplies
- Incontinence supplies
- Oral care items
- Pain relievers
- Sleep aids
- Wart removal remedies
For a complete list of covered items for plans you are considering, refer to your plan coverage terms and conditions or speak with a company representative.
Where Are Medicare OTC Cards Accepted?
Some plans provide a debit or prepaid reward card, a Medicare flex card, to cover OTC costs at qualifying locations. Other plans offer a paper or online catalog that includes covered OTC items and often requires you to purchase such items online or through a preferred pharmacy or network as outlined by the insurance plan.
Many plans are structured so their Medicare OTC cards are accepted at major US retailers. Popular retailers that often accept such cards include:
- CVS
- Walgreens
- Dollar General
- Kroger
- Family Dollar
- Walmart
- Target
To ensure you get the most out of your Medicare Advantage plan and OTC card, you’ll want to ensure that your card is accepted where you typically shop or at a convenient location before signing up.
Do You Need a Medicare OTC Card?
If you’ve worked for ten years or 40 quarters and reached 65, you likely qualify for Medicare. Since Original Medicare doesn’t cover healthcare costs, like prescription drugs, over-the-counter drugs, and dental services, many opt for a Medicare Advantage plan that does cover these costs. However, if coverage for these extra items isn’t of concern to you or a priority, then Original Medicare might make the most sense and reduce your overall costs for health insurance.
Other Medicare Supplement plans, referred to as Medigap plans, might be a better fit for you. Medigap plans might not cover over-the-counter drug and healthcare costs, but they tend to cover copayments, coinsurance, and deductibles that Original Medicare doesn’t.
Before selecting a Medicare Advantage plan, it’s important to do your research to determine what insurance options are best for your overall needs and priorities. That way, you can decide if a Medicare Advantage plan with an OTC card option is worth it in the long run for your needs and budget.
Resources
Not hyperlinked
https://www.helpadvisor.com/medicare/does-medicare-pay-for-over-the-counter-otc-drugs
Hyperlinked
https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare