Who Qualifies for an Over-the-Counter (OTC) Card?

Over-the-Counter (OTC) cards are a specialized benefit designed to assist individuals with health-related expenses. Issued by specific health plans, these cards function like prepaid debit cards, allowing members to purchase eligible health and wellness products. The funds are intended for non-prescription items, providing a supplemental financial resource for common health needs.

Eligibility for an OTC Card

Qualification for an Over-the-Counter (OTC) card is directly linked to enrollment in certain Medicare Advantage (Part C) plans. These plans are offered by private insurance companies as an alternative to Original Medicare, providing the same level of coverage along with additional benefits. Not all Medicare Advantage plans include an OTC card benefit, as its inclusion is at the discretion of the individual plan.

Original Medicare does not offer coverage for over-the-counter items. Consequently, individuals enrolled only in Original Medicare will not receive an OTC card. The OTC card is a supplemental benefit exclusively available through specific Medicare Advantage plans. About 88% of people with individual Medicare Advantage plans had OTC benefits in 2024.

Some Medicare Advantage plans may offer enhanced benefits, including higher OTC allowances, to specific populations. This can include individuals with chronic health conditions or those who are dual-eligible for both Medicare and Medicaid. To determine if an OTC card is part of a plan, prospective enrollees must review the specific benefits of the Medicare Advantage plans available in their area. Checking the plan’s summary of benefits or Evidence of Coverage (EOC) documentation is recommended to confirm the inclusion of OTC benefits.

Receiving and Activating Your Card

After successfully enrolling in a Medicare Advantage plan that includes the OTC card benefit, the card is typically mailed directly to the member’s address. The card arrives pre-loaded with a specific allowance, ready for use once activated.

Upon receiving the OTC card, activation is generally required before it can be used. Common activation methods include calling a toll-free number provided with the card or activating it online through a dedicated plan portal. The instructions for activation are usually included in the card’s accompanying documentation.

Once activated, members can typically check their card balance and monitor expiration dates through online accounts provided by their insurance company. Some plans also offer mobile applications for convenience in managing the card. The funds on the card are usually loaded on a monthly or quarterly basis, depending on the specific plan’s structure.

Using Your OTC Card for Purchases

An OTC card functions much like a debit card at checkout, allowing members to pay for eligible health-related items. These cards can be used at a wide network of participating retailers, including major pharmacies, convenience stores, and supermarkets. Many plans also facilitate online ordering through specific portals or affiliated retail websites, often with direct delivery to the member’s home.

The types of items eligible for purchase with an OTC card generally include a range of over-the-counter medications and health supplies. Common examples are cold and flu remedies, pain relievers, first aid supplies, bandages, certain vitamins and supplements, and personal care items like dental hygiene products. Some plans may also cover items such as blood pressure monitors or other health aids. It is important to consult the plan’s specific catalog or online portal to confirm eligible items, as these can vary between plans.

There are important limitations regarding the use of OTC cards. The card is typically pre-loaded with a specific allowance, and any unused funds often do not roll over to the next month or quarter. This “use it or lose it” policy encourages members to utilize their benefits regularly. Additionally, OTC cards generally cannot be used for prescription medications, medical services, or general groceries, unless the plan specifically includes these as an enhanced benefit for certain conditions. When purchasing items, if the total exceeds the card’s balance, the remaining amount must be paid using another form of payment.