What Does an OTC Card Cover?

An Over-the-Counter (OTC) card is a benefit provided by certain health plans, most commonly Medicare Advantage plans, to help enrollees manage health-related expenses. This card functions similarly to a prepaid debit card, pre-loaded with a set amount of funds by the insurance provider. Its purpose is to enable members to purchase eligible health and wellness products, making everyday health items more accessible and affordable for plan members.

Eligible Purchases

OTC cards cover a wide array of health and wellness products that do not require a prescription. These include common over-the-counter medications such as pain relievers, cold, flu, and allergy remedies. Digestive health products, including antacids and fiber supplements, are also covered.

Beyond medications, the cards extend to various first-aid and medical supplies. This category encompasses items such as bandages, antiseptic wipes, gauze, and general first-aid kits. Health monitoring devices, like blood pressure monitors, thermometers, and blood glucose meters with their associated supplies, are eligible purchases.

Personal care items, designed for hygiene and daily health maintenance, are also included, ranging from toothpaste, mouthwash, and dental floss to sunscreen and certain skincare products.

Vitamins, minerals, and dietary supplements qualify for purchase with an OTC card. Some plans may also cover medical supplies such as incontinence products, braces, or supports. However, durable medical equipment like canes or wheelchairs are not covered, nor are cosmetic items or prescription medications.

Using Your OTC Card

Using an OTC card for eligible purchases is a straightforward process, similar to using a standard debit or credit card. When shopping at approved retail locations, the card can be swiped at the point of sale. In some instances, if prompted, selecting “credit” and skipping a PIN entry is the correct procedure, as these cards do not have an associated PIN.

For online purchases, cardholders can enter the card details on a specific plan-approved website or a general retailer’s website that accepts the card. Many participating retailers, including major pharmacies and grocery stores, have systems in place to identify eligible items at checkout. If a purchase includes both eligible and ineligible items, the OTC card will cover the eligible portion, and another form of payment will be required for the remaining balance.

Understanding Your Specific Plan Details

The specific benefits and rules governing OTC cards vary among health plans and insurance providers. The amount of funds loaded onto the card, the frequency of these loads (e.g., monthly, quarterly, or annually), and whether unused balances roll over to the next period are all plan-dependent details. While some plans may allow rollovers, many stipulate that unused funds expire at the end of each benefit period.

To find the list of eligible items, accepted retailers, and card balance, members should refer to their plan’s specific resources. These resources include the plan’s online member portal or a dedicated website for OTC benefits. Additionally, the plan’s benefits catalog, welcome packet, or Evidence of Coverage (EOC) document contain information. Contacting the customer service number located on the back of the OTC card or plan ID card provides another way to clarify questions.