Does Medicare Pay for Over-the-Counter (OTC) Drugs?

In this article...
  • Learn the difference between Original Medicare and Medicare Advantage Plans. Find out which plans may pay for over-the-counter (OTC) drugs and products.

Whether you're a recent Medicare enrollee or a longtime member, you may worry about getting the best coverage. You may wonder whether it makes sense to switch to a Medicare Advantage Plan or stay with Original Medicare Parts A and B. If you take prescription drugs, you may have doubts about which Medicare D plan is suitable. Finally, if you find yourself spending hard-earned dollars on non-prescription items, you may want to know if Medicare pays for over-the-counter (OTC) drugs.

The above questions can be answered. It just takes a little bit of research on your part. First, making an informed choice means understanding how Medicare works.

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.

Seniors with Original Medicare who need prescription drug coverage must add on a Part D plan. These plans will have a listing of covered drugs, called a formulary. Often, drugs are divided into tiers, with those in the top tier costing less (per copayment) than those in lower tiers. Medicare Part D doesn't pay for over-the-counter drugs and even excludes some prescription drugs, such as those for erectile dysfunction, weight management and hair regrowth.

Medicare Advantage

Medicare Advantage, or Medicare Part C, is another option for older adults to consider. Although Medicare Advantage Plans must cover everything Original Medicare A and B do by law, most plans provide more benefits.

The majority of Medicare Advantage Plans include prescription drug coverage, and plan members are generally prohibited from purchasing a stand-alone Medicare Part D plan.

Medicare Advantage Plan Perks

Enrollees in Medicare Advantage Plans may enjoy the following extra coverages.

  • Over-the-counter (OTC) drug allowance
  • Vision
  • Dental
  • Preventative services, such as Silver Sneakers and health club memberships
  • Transportation assistance
  • Home care assistance

Does Medicare Pay for Over-the-Counter (OTC) Drugs?

Specific Medicare Advantage Plans may help pay for over-the-counter (OTC) drugs; however, the mechanics 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 contracted neighborhood pharmacy or ordered online.

Another option involves using a prepaid reward or debit card. In this case, the Medicare Advantage Plan loads a specified amount of money on the card per month or quarter. Covered OTC supplies can be paid using this card. Once the card balance is zero, the payment allowance ends. The card is reloaded at the beginning of the next set period.

What Does My OTC Card Pay For?

Some over-the-counter (OTC) drugs that Part C Medicare plans may cover include:

  • Incontinent supplies, such as adult diapers, pads and wipes
  • Cold remedies
  • Digestive aids
  • Oral care items

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.

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