Does Medicare Cover Over-the-Counter Products?
Navigate Medicare's stance on over-the-counter products. Understand the varying ways your plan might assist with common health and wellness essentials.
Over-the-counter (OTC) products are health items available without a prescription, ranging from pain relievers to vitamins. These products are regulated by agencies such as the Food and Drug Administration (FDA) to ensure safety and proper labeling. Medicare is a federal health insurance program that helps Americans with healthcare costs. Understanding its coverage for OTC products can significantly impact personal spending.
Original Medicare and OTC Products
Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover over-the-counter products. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B covers medically necessary services, including doctor visits, outpatient care, and certain medical supplies, along with preventive services.
Most OTC items are not considered medically necessary under Original Medicare’s guidelines. This means common items like non-prescription pain relievers or bandages are not covered. Original Medicare focuses on services and supplies requiring a doctor’s prescription or administration in a clinical setting.
Medicare Advantage Plans and OTC Benefits
Medicare Advantage (Part C) plans are offered by private companies approved by Medicare. These plans often include additional benefits beyond Original Medicare, such as allowances for OTC products, which are a significant draw for many beneficiaries. In 2025, approximately 73% of Medicare Advantage plans covered over-the-counter benefits, indicating widespread availability.
These OTC benefits are typically structured as a specific dollar amount provided periodically, like quarterly or monthly. For example, an enrollee might receive a prepaid debit card with a set allowance to spend on eligible items. Unused funds generally do not roll over to the next period. Common items covered by these allowances include first aid supplies like bandages, non-prescription pain relievers such as acetaminophen or ibuprofen, cold and flu remedies, vitamins, and certain personal care items.
Medicare Part D Plans and OTC Coverage
Medicare Part D plans are prescription drug plans offered by private companies. These plans primarily cover the cost of prescription medications. Generally, over-the-counter products are excluded from Medicare Part D coverage under Social Security Act Section 1860D-2.
However, limited exceptions exist. A Part D plan might cover an OTC product if it is prescribed by a doctor and meets specific criteria to be considered a “prescription drug” for a particular medical condition. This can happen if the OTC drug is part of a drug utilization management program or a step therapy protocol, often as a cost-effective alternative to a more expensive Part D drug.
How to Access OTC Benefits
Beneficiaries enrolled in Medicare Advantage plans with OTC benefits can access their allowances through several methods. Many plans provide a pre-loaded debit card, sometimes called a flex card or UCard, usable at participating retail stores. Another method is ordering items through a plan-specific catalog, available online or mailed. Some plans also allow phone orders.
Beneficiaries should review their plan’s specific benefit details, including the catalog of approved products, spending limits, and expiration dates for funds. It is generally advised to utilize the allowance before the benefit period ends.