What caregivers should know about the drugstore Medicare Advantage benefit

Serving as someone’s caregiver can be rewarding. But it can also be stressful. Unexpected costs are a part of that stress, and a 2021 study notes that family caregivers spend an average of 26 percent of their own income on caregiving activities. Half of caregivers say they’ve used their own money on household-related expenses.¹

If your loved one has a Medicare Advantage plan, however, help may be on the way. The Medicare Advantage OTC benefit may pay for hundreds of dollars of useful, over-the-counter products — personal hygiene items, supplements, pain medications and more.

The benefit from many plans can be used at participating CVS® stores. Learn more below about the details.

In this article:

• What is the Medicare Advantage OTC benefit?
• How can a caregiver use the OTC benefit on behalf of the member?
• How can you get the most out of this benefit?
• Special considerations when shopping for people as they age

What is the Medicare Advantage OTC benefit? 

About 80 percent of Medicare Advantage plans include the over-the-counter (OTC) benefit.² It provides eligible members with an allowance to pay for certain products found at the drugstore — products that can help you stay well or move through an illness. Hundreds of items are on the approved lists, including toothpaste, pain relievers, cold and flu medicines and much more.³ Members can use this benefit at CVS stores.

Each health plan’s OTC benefit is a little different, so you’ll need to look at the specific plan. But often they allow up to $100 in expenses each quarter. Note that in many plans, unspent allowance does not carry over to the next quarter. So you must “use it or lose it.” Others allow unused benefits to roll over to the following quarter, though the allowance must be spent by the end of the year.⁴

Most people who have this valuable benefit aren’t aware or don’t take advantage of it. About 70 percent of the available OTC benefits go unspent each year in the United States.⁵

How can a caregiver use the OTC benefit on behalf of the member? 

Using the OTC benefit is easy. In many cases, plan providers issue a card that a member or caregiver can use at participating stores. Purchase eligible OTC products at the checkout. Be sure to check with your Medicare Advantage plan for any limitations on where you can use the card and what items you can use it for.

At participating CVS stores, caregivers may use this benefit on behalf of the member with the member’s permission. The caregiver may be asked to provide the member’s health plan card or their name and date of birth at checkout. The cashier may ask for additional identification to verify eligibility.

How can you get the most out of this benefit?

Check the health plan’s website for guidelines on covered products. Make a list of the various eligible OTC products that the member needs every day — and ask the member for any items you may have missed, such as hygiene or personal care products.

Keep in mind that most OTC benefit plans cover the costs of much more than items for restocking the medicine chest. For instance, you can make visits to the bathroom safer with grab bars, a rubber bath mat and a shower chair, as well as a raised toilet seat — all items that may be included in provider plans.⁷ Walking canes and walkers, blood pressure monitors and COVID-19 tests may also be included.

Get smart about using the benefit with a month-by-month plan and by following additional tips.

Special considerations when shopping for people as they age

It’s important to bear in mind that seniors often have unique and changing needs when it comes to OTC products.

Remember to consult with a health provider before using any supplements or OTC medications as they may interact with prescription medications.⁸