Not all health issues and sickness require specialized treatments or surgeries. At least not right from the beginning. An eventual progression of the disease may become so complicated that the patient has no choice but to have a specialized procedure done. Otherwise, there are basic, generic medications that easily treat common colds and stomach bugs without requiring a doctor’s prescription. That is why this is referred to as over the counter drugs.
Medicare Advantage Over-the-Counter Drugs
(OTC) drugs are medicines that are sold direct to customer without a legal or systematic requirement of a prescription from a healthcare professional. Unlike prescription drugs that, as the name suggests, do require you to legally acquire a prescription from a genuine healthcare practitioner and present it to the pharmacy to acquire the specialized drugs.
OTC drugs are highly regulated for your safety. They need to ensure that such drugs do not contain any ingredient that may be immediately harmful. Hence, only those drugs with safe and effective ingredients are approved. If they provide quick relief against the illness they will make it to the over-the-counter drugs list. They can then be acquired without a physician’s prescription.
Moreover, they are only to be supplied to the consumer with a valid prescription. Over-the-counter drugs are regulated by their APIs, their active pharmaceutical ingredients. This works as a win-win for both the authorities and the pharmaceutical companies. They get the freedom to formulate ingredients and their combinations into proprietary mixtures. These can be consumed in any form, i.e., pills, syrups.
What Drugs are OTC Classified?
Certain drugs are legally classified as OTC. They may only be allowed to be dispensed by the pharmacist after they have assessed the patient. They really do need it to require any additional patient education for a decision. Furthermore, the laws and regulations even state that in which establishment these drugs are sold, in what conditions, and who holds the authority to dispense them.
Prescription drugs are so specific and specialized. The chances that anybody else may use your prescription or share your medication is with you is near to impossible. However, the prescription is not needed with OTC drugs, and you buy almost any amount you may feel will suffice. Hence, with OTC drugs, there is a higher chance of illegal activities and negative impacts. All the regulations in place are to mitigate this high risk of over-the-counter drugs.
What are Medicare OTC Benefits?
If already a beneficiary of the Medicare, then that automatically makes you eligible for Medicare Advantage Plans. Alongside these plans, you receive a variety of choices in order to make an informed decision. You choose what you think fits best with your requirement or the situation. Then, if you feel that you need assistance, ask a health insurance agent for help.
OTC benefits are a sub-part of the Medicare Advantage plans. They are dealt with based on how the private insurance firms decide. Each company may have its own agenda. You can easily compare their plans and purchase what you think would work the best for you. The whole idea is to stay within the plan’s arrangement. This allows yourself the chance to take advantage of these provisions under Medicare Advantage plans.
In addition, it is up to you that how you make the most of your OTC benefits. An unspent benefit allowance does not carry on to the next quarter. The company would ring you over to make the necessary payments, so what do you do now? Also, do not go over your monthly over-the-counter drugs benefit allowance. You will be responsible for the additional cost that will now cost you twice as much. It will not even come under your PDP out-of-pocket costs. None of them merge over with the payments for treatments and drug costs. Furthermore, because your OTC plan is regulated, all your purchase receipts must be submitted before the next quarter.
What is the Medicare Advantage Over-the-Counter Drug Card?
Any healthcare insurance firm that you may associate with your OTC drugs benefit may create your credentials and hand over a Medicare Advantage OTC drug card to you. This card is not an identification card to showcase if you are legally eligible to purchase these drugs but more so for the pharmacy to know your OTC benefit allowance. It is a prepaid subscription card that gets charged according to your plan, and you can use it to buy most health products and drugs.
Because your insurance carrier is responsible for charging and reloading your card every quarter, any difficulty with using it for payments and purchases should directly lead you to their customer service helpline to learn what might be the issue. However, most major retail stores suffice and are used to charging the Medicare Advantage OTC drug cards, so there shouldn’t be an issue. As long as the card has a feasible allowance left as per your plan, you’re good to go.
How Can I Get a Medicare Advantage Over-the-Counter Drug Card?
Many people wonder how easy or complicated might the procedure be to get a Medicare Advantage over-the-counter drug card. However, Original Medicare is different from Medicare Advantage, and consequently, both are different with your OTC benefit. Therefore, eligibility with either doesn’t guarantee you an OTC card which is a completely separate condition to fulfill. The process itself isn’t as daunting, and receiving OTC benefits is mainly your insurance agent’s concern. If you need an OTC and you have a Medicare agent, then they can get it for you. From there on, it becomes an easier and hassle-free process.
The overall coverage is actually part and parcel of the Medicare Advantage policies. This is why they are referred to as all-in-one plans. As you get enrolled in that policy to acquire the benefits, you automatically signup to receive the OTC drugs benefits, and it is just about the matter of activation. Your insurance carrier will then provide you with the necessary resources, and they typically have a website where you can check out the eligible products to buy.
These resources are online via a website, 24/7. Your agent or expert can help you utilize the OTC benefits fully. In fact, these resources are packed with information and just require a keen eye to go through them.
Will Medicare Advantage Policies Help Pay for Your Over-the-Counter Drugs?
Your Medicare Advantage OTC drug card is part of the Medicare Advantage policy. Therefore, it allows you a processed allowance for medications, health products, and drugs. According to Health Scape, last year, almost half of the beneficiaries, that is, 51% of them that had Medicare Advantage plan enrolled in relation to the plan that provides them with over-the-counter benefits. This card is basically your OTC holy grail, and you need to keep it safe with you always.
Medicare Advantage plan providers seek pharmacies and often partner with large retail medication providers. Additionally, some of these Medicare Advantage policies and OTC benefits also allow beneficiaries to acquire home delivery services. This means that your local pharmacy can deliver them to you and that too without any extra surcharge. However, it depends on the specific plans that you have picked for yourself and your insurance carrier. You don’t need to get every bit of it.
Furthermore, for any additional information, you can easily contact your insurer and ask them about how the policy works. The chances are that a discussion allows you to better understand the workings of your OTC benefit. Then you are able to utilize it more efficiently.
Which OTC Medications Can You Get with A Medicare Advantage Plan?
Over-the-counter medicine, also known as OTC or non-prescription drugs, refers to any medicine, health products, and drugs that you can easily buy without a prescription. These drugs are generally safe, effective and if you follow the dosage instructions on the label or as directed by your healthcare professional, there aren’t any harmful effects. Even then, people tend not to wrap their heads around the drugs they can purchase under OTC.
This scenario’s primary reason is obviously that Medicare is a specialized program for ages 65 and above. At that age, you are more prone to illnesses than ever because of aging and consequently deteriorating health. However, when you can buy OTC drugs generally without a prescription, why pay a quarterly or monthly payment to acquire them? The answer to that is because it saves you money for the many OTC drugs that are costly even one time. Getting a much-needed OTC medication has never been cheaper or easier before OTC benefits. Check your Advantage OTC catalog and see what your insurance carrier and Medicare have as an approved OTC drug list.
It is important to note here that due to OTC benefits provision being handled by private insurance carriers, a complete list of all the medications is susceptible to change and can’t be disclosed as a fixed mandated regulated regime. In order to receive full-blown insider information to purchase your Medicare Advantage plan and acquire OTC benefits, talk to your insurance provider. However, with that being said, most Medicare Advantage OTC benefit policies do include the following:
- Band-aids
- Sleeping aids
- Pain relievers
- Flu medication
- Essential vitamins
- Antibiotic ointment
- Orthopedic support
- Digestive medications
- Wart removal products
- Denture related products
- General first-aid materials
- Cold and cough medications
At Which Stores Can You Use Your Medicare Advantage Over-the-Counter Card?
As we discussed earlier, any pharmacy or store that is equipped and knowledgeable about charging your Medicare Advantage OTC drug card should allow you to purchase OTC drugs. There is a probability or legal rotation requirement under certain Medicare policies that ban the beneficiary from purchasing drugs from a certain store. Moreover, it also prohibits the beneficiary from making OTC purchases with unlicensed individuals illegally.
In addition medication lists can be different between companies. As well as their preferred pharmacy list. Different pharmacies and stores work with Medicare networks and insurance carriers as partners to provide over-the-counter products that you are most likely to receive. Please see list below for reference.
- CVS
- Family Dollar
- Rite Aid
- Kroger
- Publix
- Walgreens
- Target
- Walmart
- Dollar General
Can You Get an OTC Drug Card Without Medicare Advantage Coverage?
Unfortunately, the answer to this is no. Because Medicare Advantage has different coverage regulations, it doesn’t cover OTC drugs unless you purchase the OTC benefit drug plan. On the flip side, this also means that even if you do have Original Medicare Part A and B or Medicare Advantage plan, if you do buy an OTC drug, you will have to pay for it yourself, and no Medicare coverage would provide for it because you haven’t signed up for OTC benefits.
So the necessary course of action is to first purchase the Original Medicare Part A and B, then become eligible for Medicare Advantage, and then sign up for the OTC benefits program with your private insurance carrier to acquire the OTC benefits. This cool benefit is definitely worth the subscription-based payments. You may never realize how often you require and pay additional amounts for many OTC products and drugs until you have not acquired them.
12 Must-Have OTC Medicine
Here we are going to share a list that we have compiled of the 12 must-have OTC medicine that you should always have in your medicine cabinet at all times. Buying these drugs, medication, and products under OTC benefits is the best and the most budgeted course of action you can take to not only minimize the risk of a health issue but to save some buck while you are at it. The 12 must-have OTC drugs are as follows:
- Acetaminophen,
- Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
- Aspirin
- Dextromethorphan
- Benadryl
- Pepto Bismol
- Gas-X
- Phazyme
- Dramamine
- Imodium A-D
- Nasalcrom
- Any brand of Band-Aids
Concluding Summary
Over-the-counter drugs don’t seem to take much out of your monthly household income budget. However, keeping track of how often and how likely you are to use such drugs becomes unlikely to predict after a certain age.
Choosing the right MA plan for yourself can be challenging as the information available from insurers is often lengthy and confusing. United Insurance is here to break down the facts and provide guidance for your best plan forward. There are several types of Medicare Advantage plans to choose from and many carriers in your service area. Contact us today! We are here to help.