How Can I Get an OTC Card From My Health Plan?

An Over-the-Counter (OTC) card is a supplemental benefit offered by certain health insurance plans. It provides a predetermined allowance for purchasing eligible non-prescription health and wellness products, making essential supplies more accessible and affordable for plan members.

Understanding OTC Cards

An OTC card functions much like a prepaid debit card, pre-loaded with a specific amount of funds by a health plan. These cards are typically offered by particular health insurance plans, such as certain Medicare Advantage plans, some Medicaid managed care plans, or even specific employer-sponsored health plans.

Common categories of items often covered include non-prescription medications, first-aid supplies, and various personal care products. The allowance on the card is typically loaded on a monthly, quarterly, or annual basis, and funds often do not roll over to the next period if unused, though some plans may allow for rollovers.

Checking Your Eligibility for an OTC Card

Eligibility for an OTC card is tied to enrollment in a health plan that offers this benefit. Most commonly, these cards are provided to individuals enrolled in Medicare Advantage (Part C) plans. Some Medicaid managed care programs may also provide OTC card benefits, although the scope of coverage can vary by state. Original Medicare (Parts A and B) does not include OTC benefits.

To determine if your current or prospective health plan offers an OTC card, review your plan’s Evidence of Coverage (EOC) document. Alternatively, you can contact your health plan provider directly via their customer service phone number or official website to inquire about OTC card availability and eligibility criteria. Existing plan members can also consult their Annual Notice of Change (ANOC) for benefit changes.

Receiving and Activating Your OTC Card

For most eligible individuals, the OTC card is typically mailed automatically to their address once their plan year begins or after enrollment is finalized. The card usually arrives with accompanying materials, such as instructions for use, a list or catalog of eligible items, and information on participating retailers. These materials are important for understanding the specific terms and conditions of your card.

Upon receiving the OTC card, activation is generally required before it can be used. This activation process often involves calling a toll-free number provided on the card or in the accompanying instructions, or by visiting a dedicated website. During activation, you may need to provide your card number and other verification details, such as your member ID or date of birth. Activating the card ensures that the loaded funds are accessible and linked to your specific health plan account.

Making Purchases with Your OTC Card

Once activated, your OTC card functions like a debit card for purchasing eligible health items. You can typically use it at approved retailers, which include major pharmacies, retail stores, and sometimes online stores or mail-order catalogs. When making an in-store purchase, you generally swipe the card at the point of sale, similar to a regular debit transaction. Some plans also support using a digital version of the card or scanning a barcode via a mobile app for in-store purchases.

To identify eligible items, you can look for specific labels in stores, check an online portal or list provided by your health plan, or consult the catalog that came with your card. Common eligible items include over-the-counter medications like pain relievers and cold remedies, first-aid supplies such as bandages, dental care products, and sometimes even healthy food items or vision care supplies. If a purchase includes both eligible and ineligible items, the card will typically cover only the eligible portion, and you will need an alternative payment method for the remainder. You can check your card’s balance by calling the number on the back of the card or by accessing your plan provider’s online member portal.