What Is Covered Under the OTC Card? (And What Isn’t)

An Over-the-Counter (OTC) card is a specialized benefit provided by certain health plans, most commonly Medicare Advantage plans, to help enrollees manage the costs of everyday health-related products. This prepaid card functions much like a debit card, loaded with a predetermined amount of funds that can be used to purchase eligible items. Its primary purpose is to make health and wellness products more accessible and affordable for plan members. The funds on these cards are typically refreshed on a monthly, quarterly, or annual basis, depending on the specific health plan’s design.

Eligible Over-the-Counter Items

The range of products covered by an OTC card is extensive, though the precise list of eligible items can vary significantly based on the health plan providing the benefit. Cardholders should always consult their specific plan’s benefit catalog or approved product list for the most accurate and current information. Many common health and wellness categories are generally included.

Pain relief items are a frequently covered category, encompassing products such as acetaminophen, ibuprofen, and topical pain relievers like medicated creams or patches. Cold and flu remedies are also widely available, including cough drops, decongestants, cough syrups, and nasal sprays.

First aid supplies form another significant category, with examples including bandages, antiseptic wipes, gauze pads, medical tape, and antibiotic ointments. Digestive health products are typically covered, such as antacids for heartburn, laxatives for constipation, and anti-diarrhea medications.

Personal care items are often included, ranging from adult diapers and other incontinence supplies to denture care products like cleansers and adhesives. Additionally, certain oral health products, such as specific brands or types of toothpaste, mouthwash, and dental floss, are frequently eligible.

Vitamins and supplements are a substantial part of the eligible items list. Common examples include multivitamins, Vitamin D, calcium supplements, and various other dietary aids. Eye and ear care products, such as eye drops for dry eyes, contact lens solutions, and ear wax removal kits, are also typically covered.

Medical devices and diagnostics are also eligible. This can include home health monitoring tools like blood pressure monitors, glucose meters and test strips, and thermometers. Other items like heating pads, cold packs, and even some basic mobility aids might also be found on eligible lists, depending on the plan.

Understanding OTC Card Exclusions

While OTC cards offer significant benefits for a wide array of health-related products, it is important to understand what items are typically excluded from purchase. General groceries or food items are usually not covered by an OTC card. Some specialized plans, however, may offer a separate healthy food benefit, which is distinct from the standard OTC allowance. Cosmetic products, beauty enhancements, or luxury personal care items are also generally excluded.

Household goods, cleaning supplies, tobacco products, and alcoholic beverages are consistently outside the scope of OTC card coverage. OTC cards are specifically designed for over-the-counter items, meaning prescription medications cannot be purchased with these cards.

Services, such as doctor visits, lab tests, or medical procedures, are also not covered by an OTC card. Certain durable medical equipment, like canes or walkers, might also be excluded depending on the plan.

Using Your OTC Card

Using an OTC card is straightforward, functioning similarly to a standard debit card for eligible purchases. The primary venues for using the card include participating retail stores, online retailers, and sometimes through mail-order catalogs provided by the health plan. Many major pharmacies, grocery stores with pharmacy sections, and general merchandise stores accept these cards.

When making a purchase at a brick-and-mortar store, cardholders typically swipe the OTC card at the checkout terminal. They may be prompted to select “credit” or “debit,” with no Personal Identification Number (PIN) usually required for OTC card transactions. For online purchases, the process involves entering the card number, expiration date, and security code. Some plans also offer dedicated online portals or apps for ordering items directly.

If a purchase includes both eligible and ineligible items, or if the total cost of eligible items exceeds the card’s current balance, the system will typically deduct the eligible amount from the OTC card. The remaining balance for ineligible items or any overage on eligible items would then need to be paid using another form of payment, such as a personal debit card, credit card, or cash.

Managing an OTC card involves several practical steps. Cardholders can check their card balance through various methods, including calling the customer service number on the back of the card, logging into the health plan’s online member portal, or checking the purchase receipt. It is important to be aware of the card’s expiration date and the benefit renewal cycles, as unused funds often do not roll over into the next period and expire at the end of the month, quarter, or year, depending on the plan.