Does Medicare cover over-the-counter (OTC) medications?

February 9, 2021
Aspire Blog - Does Medicare cover over-the-counter (OTC) medications

Recently, we wrote about what’s missing from Original Medicare. One key thing is prescription drug coverage, which can be purchased through a Medicare Part D plan or by enrolling in a Medicare Advantage (MA) plan with Part D coverage (MAPD). But we also know some of the medications and health-related items you need may not require a prescription.

There’s good news! Over the last few years, the Centers for Medicare & Medicaid Services (CMS) has given MA plans the flexibility to offer supplemental benefits such as over-the-counter (OTC) medication allowances. This allows you to purchase select, eligible health and wellness items like allergy pills, cold and flu products, first aid supplies, vitamins and more.

This is important because Original Medicare and Medicare Part D do not pay for OTC drugs. This includes:

  • Medications used for hair growth or other cosmetic reason
  • Medications used to treat cold or cough symptoms
  • Medications used to treat sexual dysfunction
  • Vitamins and minerals
  • Weight gain or weight loss medications

According to the Consumer Healthcare Products Association (CHPA), the average person in the U.S. makes 26 trips each year to purchase OTC products. We assume this number increases as you age, so every penny counts. An OTC allowance gives you an allotted amount – usually per month or per quarter – not to be exceeded. MA plans offering an OTC allowance usually have a catalog with approved products to choose from.

More good news – pharmacies have a mail-order feature so you can have many of your products (and even prescription items) shipped straight to your door – usually at no cost to you! Products can be ordered by mail, phone or online.  Note the exact OTC allowance amounts and other benefits of MA plans vary.

If you have any specific questions about your MA plan’s benefits, remember to contact their member services team directly. Aspire Health Plan members can call (855) 570-1600. (TTY users call 711.)

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Discussion:

  • March 9, 2021 at 11:56 pm, Ruth Lacap says:

    I belong to Aspire Health Plan Plus. I’m having trouble finding the site to order my otc for my plan/

  • August 16, 2021 at 3:55 pm, Ron Olson says:

    I am new to Mericare effective 8/1/21. Is there an on-line catalogue? What is the web address.
    Thanks!

    • August 17, 2021 at 7:18 pm, Aspire Health Plan says:

      Hi Ron!

      If you have a Medicare Advantage (MA) plan, you may have an OTC allowance benefit. Contact your plan’s Member Services team using the phone number on the back of your insurance ID card. They will be happy to help you!

      If you have Original Medicare (Parts A and B) only, unfortunately you do not have an OTC allowance benefit.

      Please let us know if you have any additional questions. We’re happy to help! Contact us at (866) 798-1530, TTY users call 711, to speak with a Health Plan Advisor.

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