An OTC (over-the-counter) card is a benefit offered by some Medicare Advantage and Medicaid plans that allows eligible members to purchase eligible health and wellness items with funds loaded onto the card each month.
This can include items like vitamins, pain relievers, and first aid supplies. If you are enrolled in a qualifying health insurance plan and eligible for Medicare Advantage or Medicaid, you may be eligible for an OTC card to purchase.
However, the eligibility requirements and guidelines can vary by plan, so it’s important to understand who qualifies for OTC card and what the requirements are for your specific plan.
In this article, we’ll explore the eligibility requirements for an OTC card, as well as provide some important tips and guidelines for making the most of this benefit.
Who Qualifies for OTC Card
An OTC (Over-The-Counter) card is a benefit offered by some health insurance plans, including Medicare Advantage and Medicaid.
The card allows individuals to purchase certain health and wellness items without having to pay out of pocket.
Not everyone is eligible for an OTC card. Here are the requirements for an OTC card and who qualifies for one.
1. Enrolled in a Qualifying Health Insurance Plan
To be eligible for an OTC card, you must first be enrolled in a qualifying health insurance plan. This usually includes Medicare Advantage or Medicaid.
These plans provide benefits beyond what traditional Medicare and Medicaid offer, and they are provided by private insurance companies that have been approved by Medicare and Medicaid.
2. Eligible for Medicare Advantage or Medicaid
To be eligible and use an OTC card, you must also be eligible for Medicare Advantage or Medicaid. The eligibility requirements for these programs can vary, but generally, you must meet certain criteria related to age, income, disability, or other factors.
Medicare Advantage is a type of Medicare plan offered by private insurance companies. To be eligible, you must be enrolled in Medicare Part A and Part B, and you must live in the service area of the plan you want to enroll in.
Some Medicare Advantage plans also require you to have a certain level of health coverage, such as prescription drug coverage.
Medicaid is a program that provides health coverage to individuals with low incomes. The eligibility requirements for Medicaid vary by state, but generally, you must have a low income and meet certain other requirements, such as being pregnant, having a disability, or being a child or young adult under the age of 26.
3. OTC Card Benefit
Not all Medicare Advantage or Medicaid plans offer an OTC card benefit. You will need to check with your plan to see if it is available. If your plan offers an OTC card benefit, you will usually receive a card in the mail or be able to access it online.
Related: Guide for using OTC card at Amazon.
4. OTC Card Balance
An OTC card typically has a set amount of money loaded onto it each month, which can be used to purchase eligible items.
The card balance may vary by plan, so check with your plan to see how much money is loaded onto your card each month.
It’s important to note that any unused funds on the card typically do not roll over to the next month, so it’s important to use the funds before they expire.
5. Eligible Items
The items that can be purchased with an OTC card vary by plan but generally include a range of health and wellness items such as pain relief medications, allergy medications, cold and flu medications, digestive health products, first aid supplies, feminine hygiene products, oral care products, vitamins and supplements, incontinence products, foot care products, and eye care products.
It’s important to note that not all items sold in a pharmacy or retail store will be eligible for purchase with an OTC card. Items that are not eligible include restricted products and non-health-related items such as clothing or electronics.
6. Non-Eligible Items
To avoid confusion, it’s important to know which items are not eligible for purchase with an OTC card. Some of the most common non-eligible items include:
- Restricted Products
- Non-health-related items such as clothing, electronics, and household items
- Prescription medications
- Vitamins or supplements that require a prescription
- Cosmetics
- Gift cards
7. Using the OTC Card
Using an OTC card is similar to using a debit card. When you are ready to make a purchase, simply present your card at the checkout and the cost of the eligible items will be deducted from the balance on your card.
If you do not have enough funds on your card to cover the entire purchase, you will need to pay the difference out of pocket.
It’s important to keep track of your card balance and only purchase items that are eligible to avoid any confusion or issues with your plan.
Related: Complete steps for getting an OTC card.
Important Tips and Guidelines for an OTC Card
Here are some important tips and guidelines for an OTC card:
- Check your plan: Not all Medicare Advantage or Medicaid plans offer an OTC card benefit. Make sure to check with your plan to see if it’s available to you.
- Know your eligibility: To qualify for an OTC card, you must be enrolled in a qualifying health insurance plan and eligible for Medicare Advantage or Medicaid.
- Understand your card balance: An OTC card typically has a set amount of money loaded onto it each month. Check with your plan to see how much money is loaded onto your card each month.
- Know which items are eligible: The items that can be purchased with an OTC card vary by plan. Make sure to check which items are eligible before making a purchase.
- Keep track of your balance: Unused funds on the card typically do not roll over to the next month. Keep track of your OTC card balance and use the funds before they expire.
- Only purchase eligible items: To avoid any confusion or issues with your plan, only purchase items that are eligible.
- Don’t forget to use your card: Using an OTC card is similar to using a debit card. Remember to bring your card with you when you go shopping and use it for eligible purchases.
Age Requirements for Qualifying for an OTC Card
The minimum age requirement for qualifying for an OTC (over-the-counter) card can vary by plan. Some plans may require that you be at least 65 years old and enrolled in Medicare, while others may have a lower age requirement for those enrolled in Medicaid.
It’s important to check with your plan to see what the age requirements are for your specific situation.
Some plans may offer OTC card benefits to younger individuals with certain health conditions or disabilities, so it’s important to explore all of your options and speak with your healthcare provider or plan representative to see if you may qualify.
Related: Using County Care OTC card guide.
Conclusion
If you are enrolled in a Medicare Advantage or Medicaid plan, you may be eligible for an OTC (over-the-counter) card that allows you to purchase eligible health and wellness items with funds loaded onto the card each month.
The eligibility requirements for an OTC card can vary by plan and may include factors such as age, income, and health status.
It’s important to understand your plan’s specific guidelines and requirements to determine if you qualify for this benefit.
By taking advantage of an OTC card, you can save money on essential health and wellness items and improve your overall well-being.
Be sure to consult with your healthcare provider or plan representative to explore your options and make the most of this benefit.
FAQ’s
How do I know if I qualify for an OTC card?
To qualify for an OTC card, you must be enrolled in a qualifying health insurance plan and eligible for Medicare Advantage or Medicaid. Check with your plan to see if it offers an OTC card benefit.
What happens if I don’t use all the funds on my OTC card each month?
Unused funds on the card typically do not roll over to the next month. Make sure to use the funds before they expire.
Do I need to pay for an OTC card?
No, OTC is typically offered as a benefit by qualifying health insurance plans through cards and is provided at no cost to eligible members.
Can I get an OTC card if I have a traditional Medicare plan?
No, OTC cards are typically only offered through Medicare Advantage and Medicaid plans. Traditional Medicare plans do not offer this benefit.