Does Medicare Pay for Over-the-Counter (OTC) Drugs?

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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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Do Medicare Advantage plans pay for OTC drugs?

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:

  • Improve preventive care
  • Reduce health care complications
  • Help keep health costs lower

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:

  • Non-emergency transportation services (such as trips to the doctor’s office)

  • Caregiver support

  • Home remodeling for aging in place (such as adding bathroom grab bars)

  • Some home-based palliative care

  • Home meal delivery

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.

Man buying drugs at the pharmacy counter

Which drugs are not covered by Medicare?

Medicare Part A and Part B typically do not cover the following over-the-counter drugs:

  • Vitamins and minerals (except prenatal vitamins and fluoride preparations, in certain situations)

  • Drugs used only for the relief of a cold or cold symptoms

  • Drugs used to treat erectile dysfunction

  • Fertility drugs

  • Drugs used to treat anorexia, weight loss or weight gain

  • Drugs used for cosmetic purposes or hair growth

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.

Find Medicare Advantage plans that offer OTC allowances

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.

 

Compare Medicare Advantage plans in your area

Compare Plans

Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

Badger, Cary. The Rise of Over-the-Counter (OTC) Programs in Medicare Advantage Plans. (April 30, 2019). HealthScape. Retrieved from https://healthscape.com/insights/the-rise-of-over-the-counter-otc-benefits-in-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.