To qualify for an OTC (over-the-counter) card, you need to be enrolled in a Medicare Advantage plan that includes OTC benefits. These cards are not available through Original Medicare (Parts A and B) or standalone Part D drug plans. Most Medicare Advantage plans offer some level of OTC allowance, but the specific amount and what it covers varies by plan.
Step 1: Be Eligible for Medicare
Before you can get an OTC card, you need to qualify for Medicare itself. There are two main paths. The first is age: you’re automatically eligible at 65. The second is disability or certain medical conditions. People younger than 65 can qualify if they have ALS (Lou Gehrig’s disease), end-stage renal disease, or a qualifying disability recognized by Social Security.
Step 2: Enroll in a Medicare Advantage Plan
Once you have Medicare, you need to choose a Medicare Advantage plan (also called Part C) that includes an OTC benefit. This replaces your Original Medicare coverage. Not every Advantage plan offers the same OTC allowance, so you’ll want to compare plans in your area during enrollment. The OTC card works like a prepaid debit card loaded with a set dollar amount each month or quarter that you can spend on approved health products.
You can enroll in or switch to a Medicare Advantage plan during these windows:
- Initial Enrollment Period: A seven-month window surrounding your 65th birthday, starting three months before your birthday month and ending three months after.
- Annual Open Enrollment: October 15 through December 7 each year. Anyone with Medicare can join, switch, or drop a plan during this time.
- Medicare Advantage Open Enrollment: January 1 through March 31. If you already have a Medicare Advantage plan, you can switch to a different one (for example, one with a better OTC benefit) or return to Original Medicare.
Special Enrollment Periods That Open a Window
Outside of those regular enrollment windows, certain life events give you a chance to switch to a plan with an OTC card. You get a two-month window to make changes if you move to a new area, leave employer or union coverage (including COBRA), are released from incarceration, move back to the U.S. after living abroad, or move out of an institution like a nursing home.
If you lose Medicaid eligibility, your window extends to three full months. And if you currently have both Medicare and Medicaid, or you receive Extra Help paying for prescriptions, you can make changes once per calendar month, with the new plan taking effect the first day of the following month.
Special Needs Plans for Chronic Conditions
If you have certain chronic health conditions, you may qualify for a Chronic Condition Special Needs Plan (C-SNP). These are a type of Medicare Advantage plan specifically designed for people with serious ongoing illnesses, and they often come with enhanced benefits, including OTC allowances. You can enroll in a C-SNP at any time during the year if you have a qualifying condition, which gives you more flexibility than waiting for the standard enrollment windows.
CMS approves 15 categories of chronic conditions for these plans:
- Diabetes
- Chronic heart failure
- Cardiovascular disorders (coronary artery disease, cardiac arrhythmias, peripheral vascular disease)
- Chronic lung disorders (asthma, chronic bronchitis, emphysema, pulmonary fibrosis)
- Cancer (excluding pre-cancer or in-situ status)
- Dementia
- Stroke
- Mental health conditions (bipolar disorder, major depression, schizophrenia, schizoaffective disorder)
- Neurologic disorders (Parkinson’s disease, multiple sclerosis, ALS, epilepsy, spinal stenosis)
- Autoimmune disorders (rheumatoid arthritis, lupus, polymyositis)
- HIV/AIDS
- End-stage renal disease requiring dialysis
- End-stage liver disease
- Severe blood disorders (sickle-cell disease, hemophilia, aplastic anemia)
- Chronic alcohol and other drug dependence
Some C-SNPs also target combinations of conditions, such as diabetes paired with chronic heart failure, or stroke combined with cardiovascular disorders.
What an OTC Card Covers
Once you qualify and receive your card, you can use it on a range of health-related products. Common covered categories include allergy, cold, and flu remedies, pain relievers, first aid supplies, incontinence products, stomach remedies, vitamins, and tobacco cessation aids. Some plans extend the benefit to healthy groceries (fruits, vegetables, dairy, meat, bread, cereals) and even utility bill credits for electricity, water, internet, and heating.
Items that are generally excluded: alcohol and tobacco products, cosmetics and hair care, candy and desserts, ice cream and frozen treats, pet supplies, and alternative medicines or supplements. The exact list depends on your plan, so it’s worth reviewing your plan documents or calling your insurer.
How to Use and Track Your Benefits
Your OTC card functions like a prepaid debit card. You can use it in-store at participating retailers, which typically include CVS, Walgreens, Walmart, Rite Aid, Kroger, Safeway, Publix, Albertsons, and Target. Many plans also let you shop through an online portal or place orders by phone.
To get started, check your plan materials for the list of accepted stores and set up an online account using your Medicare Advantage member ID. Through that portal, you can browse eligible products, place orders, and check your remaining balance. Most plans load a set amount each month or quarter, and unused funds typically do not roll over to the next period. Spending your full allowance each cycle helps you get the most from the benefit.