Understanding OTC Benefits
Some Medicare Advantage plans may include an Over-the-Counter (OTC) benefit. Availability, amount, and rules vary by carrier, plan, county or service area, state, eligibility, and plan year.
Clear Point Senior Advisors is an independent insurance agency. Not connected with or endorsed by Medicare, CMS, or the U.S. government. Plan availability varies by location. We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Understanding OTC Benefits
Some Medicare Advantage plans may include an Over-the-Counter, or OTC, benefit. This benefit may help members pay for certain health-related items approved by the plan that do not require a prescription.
What OTC may cover
Certain plan-approved health-related items that do not require a prescription.
How the allowance may work
Monthly, quarterly, or annual allowance depending on the plan. It may use a card, catalog, online portal, phone order, or participating stores.
Why it varies
OTC can vary by carrier, plan, county/service area, state, eligibility, and plan year.
What to verify
Review the Summary of Benefits, Evidence of Coverage, and carrier materials before relying on any OTC amount or card rule.
Some plans: food, groceries & help with bills
Beyond regular OTC items, some Medicare Advantage plans may offer an expanded card that can help pay for healthy food, groceries, or certain utility bills (such as electric or gas). These expanded benefits are not in every plan and usually require additional eligibility — for example Medicaid, Extra Help/LIS, a qualifying chronic condition, or a Special Needs Plan (SNP). Amounts and rules vary by carrier, plan, county or service area, and plan year.
This is general education, not a guarantee of benefits. A licensed advisor can verify what a specific plan in your county actually offers.
OTC benefits are not the same in every plan. The amount, how often it renews, where it can be used, how items are ordered, and which products are allowed can vary by insurance company, plan, county or service area, state, eligibility, and plan year. In New York, New Jersey, and Connecticut, OTC benefits must still be checked by the exact plan available in the person’s county or service area.
Some plans may provide a monthly allowance. Others may provide a quarterly or annual allowance. In many plans, unused amounts may not roll over. Some plans use a card, catalog, online portal, phone order, or participating retail stores.
Some Medicare Advantage plans may also offer expanded card benefits for food, groceries, utilities, or other special supports. These benefits are different from regular OTC and may require additional eligibility, such as Medicaid, Extra Help/LIS, a qualifying chronic condition, SNP status, or other plan-specific rules.
OTC benefits do not replace medical coverage or prescription drug coverage. Benefits can change each year. Before choosing or changing a plan, it is important to review the plan’s Summary of Benefits, Evidence of Coverage, and carrier materials. Clear Point can help explain and organize the information for a licensed advisor review.
How We Help
Clear Point can help explain and organize plan information, but the licensed advisor must verify plan details and the client decides. Final eligibility, plan availability, and OTC rules are determined by the carrier and the plan’s service area.
Call 1-855-720-8555Some expanded card benefits (food, utilities, flex supports) may require Medicaid, MSP, or other eligibility. Those programs are covered on a separate page. See Help Paying Costs
Get Your Free Plan Review
Takes 2 minutes · No pressure · Confidential
We protect your information and only use it to connect you with a licensed advisor.
Reply STOP to unsubscribe. Message frequency may vary.
Clear Point Senior Advisors is an independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability, benefits, premiums, provider networks, drug coverage, and costs vary by plan, location, and eligibility. A licensed insurance agent may contact you to discuss Medicare-related options. You can also contact Medicare.gov or 1-800-MEDICARE for official information.
Want to Check If a Plan’s OTC Benefit Fits Your Area?
A licensed advisor can review the exact plan available in your county or service area. OTC availability, amount, and rules vary by carrier, plan, eligibility, and plan year.