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 senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.