Original Medicare (Part A and Part B) doesn’t typically cover prescription medication. If it does, it’s in only limited circumstances. So do Medicare beneficiaries have any options for coverage of over-the-counter (OTC) medications?
As it turns out, some Medicare Advantage (Medicare Part C) plans may provide allowances for OTC drugs and other products. Medicare Advantage plan availability and benefits may vary, depending on where you live and the plan you have.
A licensed insurance agent can help you compare Medicare Advantage plans in your area that may provide coverage that includes allowances for over-the-counter medications.
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In 2019, more than 51 percent of Medicare Advantage beneficiaries were enrolled in a plan with OTC benefits.1
This is due in part to the Centers for Medicare and Medicaid Services (CMS) giving Medicare Advantage plan carriers more flexibility in the benefits that Medicare Advantage plans can offer.
This move was designed to:
This opened the door for Medicare Advantage plans to begin including coverage for things such as over-the-counter medication allowances as part of their benefit lineup.
Some of the other newly expanded Medicare Advantage benefits include (but aren’t limited to) things like:
Medicare Advantage plans may sometimes partner with a national retail pharmacy like Walmart or CVS where plan members may utilize their OTC benefit. Some Medicare Advantage plans may also offer home delivery of over-the-counter drugs.
The exact OTC allowances and other benefits of Medicare Advantage plans may vary. Some Medicare Advantage plans feature $0 premiums, though these types of plans may not be available where you live.
Medicare Part A and Part B typically do not cover the following over-the-counter drugs:
Prescription drugs that fall into the above categories may be covered by Medicare if they are being prescribed to treat other conditions and are ordered by your doctor. Speak with your health care provider for Medicare coverage information.
Medicaid may help cover OTC medications in certain states
State Medicaid programs may cover many over-the-counter medications when deemed medically necessary by a health care provider.
Medicaid programs are administered by individual states, so coverage and benefits may vary.
A licensed insurance agent can help you compare Medicare Advantage plans that are available where you live. Depending on the plans available in your area, you may be able to find a plan that offers an allowance for OTC medications.
Speak with a licensed insurance agent
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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