Most Medicare Advantage members have an OTC (over-the-counter) benefit and have never used it. Industry surveys consistently show that more than half of eligible members leave their full OTC allowance unclaimed each year. That is real money your plan is setting aside for you, and it does not roll over.
Here is what it is, how it works, and what you can get with it.
What Is the OTC Benefit?
The OTC benefit is a quarterly or annual allowance your Medicare Advantage plan gives you to spend on approved health items. Think of it as a prepaid health shopping card, loaded with money from your plan each quarter, for items you would otherwise buy out of pocket.
It is one of the most underused supplemental benefits in Medicare Advantage, and one of the easiest to access once you know it exists.
How Much Is the OTC Allowance?
The amount varies by plan. Typical allowances range from $50 to $200 per quarter ($200 to $800 per year). Some plans offer more. The exact amount is listed in your plan's Summary of Benefits. If you are not sure, call Member Services and ask: "What is my OTC allowance and how do I use it?"
What Does the OTC Benefit Cover?
Covered items vary by plan but commonly include:
- Blood pressure monitors and cuffs
- Pulse oximeters
- Blood glucose monitors and test strips
- Compression socks and stockings
- Medical alert systems (PERS devices)
- TENS units for pain relief
- Incontinence supplies
- First aid supplies
- Vitamins and supplements (on many plans)
- Hearing aid batteries (on some plans)
Most members assume the OTC benefit only covers basics like bandages and vitamins. In reality, many plans cover blood pressure monitors, glucose meters, and medical alert devices. These are items that cost real money and have a meaningful impact on health and safety at home.
How Does It Work?
Most plans offer one of three ways to spend your OTC allowance:
Online ordering through your plan's member portal. Browse the approved catalog, add items to a cart, and have them shipped to your home for free.
Mail-order catalog that your plan sends you each year. Call the number in the catalog to order by phone. This option is designed for members who prefer not to order online.
OTC benefit card that works like a debit card at approved retailers including Walmart, CVS, Walgreens, and Dollar General. Only eligible items will process at checkout. Non-eligible items in your cart will require you to pay out of pocket.
Does the Balance Roll Over?
Usually no. Most plans reset the OTC allowance at the start of each quarter. If you do not use it by the end of the quarter, you lose it. The quarterly reset dates are typically January 1, April 1, July 1, and October 1.
Set a calendar reminder for the first week of each quarter to check your balance and place an order. Even if you do not need anything urgently, stocking up on items you use regularly (compression socks, first aid supplies, batteries) is a smart way to use the allowance before it resets.
How to Check Your Balance
Call Member Services at the number on the back of your insurance card, or log into your plan's online member portal. If your plan gave you an OTC benefit card, there is usually a number on the back of the card specifically for balance inquiries.
Ask for: your current OTC balance, a list of covered items, and the expiration date of the current quarter's allowance.
Common Items Members Miss
The items most members overlook are the higher-value ones: blood pressure monitors ($40 to $80), glucose test strips (ongoing cost), and medical alert systems ($25 to $40 per month). These are not luxury items. They are tools that help you or your family member stay healthy and safe at home, and your plan is willing to help cover them.
