Does Medicare Pay for Over-the-Counter (OTC) Drugs?
- Medicare Advantage plans may pay for over-the-counter (OTC) drugs and products, while Original Medicare (Part A and Part B) typically does not. Learn more about how to find Medicare Advantage plans that cover over-the-counter products.
While Original Medicare (Medicare Part A and Part B) doesn't cover over-the-counter (OTC) drugs, Medicare Advantage (Medicare Part C) plans may cover over-the-counter drugs and other health products.
Medicare Advantage plans are offered by private insurance companies and are required to cover everything Original Medicare covers. Many plans offer extra benefits not covered by Original Medicare, such as prescription drugs.
In 2023, 87% of Medicare Advantage plans cover over the counter benefits.1
When Does Medicare Pay for Over-the-Counter (OTC) Drugs?
Specific Medicare Advantage Plans may help pay for over-the-counter (OTC) drugs; however, the rules and costs vary according to the Medicare Advantage Plan you choose. Some plans provide members with an online or paper catalog that lists all covered OTC items. Usually, these products need to be purchased from a network or preferred pharmacy or ordered online.
Some plans with over-the-counter benefits may use a prepaid reward or debit card, sometimes referred to as a Medicard flex card. In this case, the Medicare Advantage plan may load a specified amount of money on the card for a set amount of time such as per month, per quarter or per year. Covered OTC supplies can be paid using this card. Once the card balance is zero, the payment allowance likely ends.
In addition to over-the-counter benefits, Medicare Advantage plans may offer extra benefits in 2023, such as:
- Vision (99% of plans)
- Dental (97% of plans)
- Fitness and health club memberships such as Silver Sneakers (99% of plans)
- Transportation assistance (43% of plans)
- Healthy meal benefits (71% of plans)
- In-home support services (14% of plans)1
What Does My OTC Card Pay For?
Some over-the-counter (OTC) drugs that Part C Medicare plans may cover include:
- Incontinence supplies, such as adult diapers, pads and wipes
- Cold remedies
- Digestive aids
- Oral care items
The Basics of Original Medicare
Original Medicare Parts A and B are very specific about what is and isn't covered. For example, Part A typically pays for inpatient hospital-related care, including surgeries and lab tests. It also covers skilled nursing services, hospice and home care.
Part B focuses more on outpatient care. This can include doctor's visits, treatments and therapies. Part B also pays for durable medical equipment such as walkers, wheelchairs and rollators.
Medicare Advantage and Medicare Part D Drug Coverage
Original Medicare beneficiaries who need prescription drug coverage can typically supplement their Part A and Part B benefits with a Medicare Part D Prescription Drug Plan (PDP), or they can get their Part A, Part B and prescription drug benefits all in a single Medicare Advantage (Part C) plan.
Bot of these types of Medicare drug plans will have a listing of covered drugs, called a formulary. Drugs are divided into tiers, with those in the top tier costing less (per copayment) than those in lower tiers. Plans may exclude some prescription drugs, such as those for erectile dysfunction, weight management and hair regrowth.
Medicare Advantage Plans are required cover everything Original Medicare (Part A and Part B) cover, and most plans provide more benefits. According to the Kaiser Family Foundation, the vast majority of 2023 Medicare Advantage Plans include prescription drug coverage.
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How to Find a Medicare Advantage Plan With OTC Drug Coverage
Medicare Advantage Plans are managed by private insurers (as opposed to the federal government) and are unique to each state. Therefore, the choices you have may be limited. Always take the time to compare costs and plan coverages before making your final decision. You can find help by working with a local insurance agent or speaking with an Area Agency on Aging counselor.
1 Freed M, et al. (Nov. 10, 2022). Medicare Advantage 2023 Spotlight: First Look. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-2023-spotlight-first-look.