What You Need to Know About Over-the-Counter (OTC) Benefits

Q: What should you do if your OTC card is declined?

If your OTC card is declined: Verify the store you're shopping at participates in the plan network; Check that the exact item is eligible; Confirm that your card has been activated; Check your remaining balance; Ask whether split payment is permitted; Save your receipt and call the number on the card.

A plain-English guide to Medicare Advantage OTC allowances—who qualifies, what’s covered, where to shop, and how to use your benefit before it expires.

Medicare over-the-counter (OTC) benefits are allowances that are included in many Medicare Advantage plans. Members can use the allowance for eligible health and wellness products, such as pain relievers, first-aid supplies, dental products, vitamins, and mobility aids. Allowance amounts, eligible products, participating stores, benefit periods, and rollover rules vary by plan. Original Medicare does not include a general OTC-product allowance.

If you’re 64+, there’s a good chance you’ve seen at least one ad talking about Medicare OTC benefits. OTC (over-the-counter) benefits are one of the extra benefits offered by many Medicare Advantage plans, and they can help people save real money on health and wellness products—as well as healthy foods in some cases!

So, how do they work, and how can you get one? Read on to find out.

The highlights you need to know

Just want a quick summary? These are the key details about OTC benefits:

OTC benefits are allowances offered by many Medicare Advantage plans.
OTC allowances can be used to purchase OTC-eligible items. Eligible items vary between plans, but generally include health and wellness products you could get at a retail pharmacy.
How much money your OTC benefit has depends on your plan, but the average senior on Medicare Advantage has $400 in OTC credits. The allowance is spread out over benefit periods that may be monthly, quarterly, bi-annual, or annual.
Where you can shop and what you can get varies based on your insurance company and specific Medicare Advantage plan. Use My OTC to quickly find your plan’s list of eligible items and place an order for free delivery.

What are OTC benefits?

OTC benefits provide Medicare Advantage plan holders with an allowance that they can use on eligible items.

The list of OTC-eligible items varies by plan, but generally includes things like over-the-counter medications (think allergy medicine, Advil, cold medicine, and digestive aids), vitamins and supplements, dental hygiene products, eye and ear care, sunscreen, incontinence products, first aid supplies, and mobility aids. For certain Medicare Advantage special needs plans, OTC benefits can also be used to purchase healthy foods and household essentials (like toilet paper).

If you’re familiar with FSA (flexible spending account) benefits, OTC benefits are very similar. Two key differences, however, are:

While FSAs all have the same list of eligible items, lists of OTC-eligible items vary between different Medicare Advantage plans. Where you can shop for OTC-eligible products also varies between insurance companies.
FSAs can be used for qualifying healthcare costs (like copays and prescriptions). OTC benefits, on the other hand, can only be used for OTC-eligible items that do not require any approval or treatment from a doctor.

How OTC benefits work, step by step

Confirm that your plan includes a benefit
Activate the card or online account if required
Check the allowance and expiration date
Find eligible products via your plan's catalog
Pay with the card or place an online, phone, or mail order
Set a reminder to use your benefit each period

How much money do OTC benefits provide?

The average senior on Medicare Advantage has $400 in OTC credits. That said, OTC allowances vary by plan. Some may offer $40 each month and others will provide over $100 each month.

How to check your OTC balance

To check your balance, you can:

Read through your Medicare Advantage plan’s explanation of benefits
Check your insurance company’s OTC app
Use our OTC balance checker

List of OTC-eligible items

The exact list of products you can buy with your OTC benefit varies between plans. Below are the categories that all OTC benefits cover:

Equally important to what is covered is what is not usually covered:

Prescription medications
Cash withdrawals
Gift cards
Alcohol and tobacco
Cosmetics and beauty products
Products outside the plan catalog
Purchases at nonparticipating retailers

What makes things complicated is that on one plan, a bottle of Advil 225 capsules may be eligible. On another, you may need to get 225 Extra Strength Tylenol Caplets to get coverage. This can make shopping in stores a bit challenging—because you can’t be sure of what is and isn’t covered by your plan’s OTC benefit. That’s why many people prefer to order OTC products online and get them delivered to their door.

Where to use OTC benefits

Like with everything else, where you can use your OTC benefits largely varies based on your insurance carrier. For the most part, OTC products can be purchased in stores, online, via mail order, or over the phone. The participating stores, websites and apps, and phone and mail ordering systems will be different for different insurance companies (UnitedHealthcare, Anthem, Aetna, Humana).

Many people don’t use their OTC benefits because it’s too complicated. If you go to a store, it can be challenging to figure out what’s actually eligible. And the apps provided by insurance carriers are clunky and confusing.

You shouldn’t have to guess at the register, spend hours trying to navigate an app, or place multiple phone calls to use your OTC benefit. That’s why we built My OTC by Chapter. It’s the same, simple experience, regardless of your plan. No guessing what’s covered, no confusion. Complete your order in 5 minutes, and get it delivered to your door for free.

How to get an OTC benefit

OTC benefits are only offered by certain Medicare Advantage plans. In 2026, 66% of Medicare Advantage plans include an OTC benefit (down from 73% in 2025 and a high of 87% in 2023). Medicare Advantage Special Needs Plans (SNPs) are much more likely to have an over-the-counter benefit. In 2026, 94% of SNPs include an OTC benefit.

If you’re interested in OTC benefits, you should consider them during the Medicare Annual Enrollment Period. It’s recommended, however, that you make sure your healthcare needs are met first before prioritizing extra Medicare Advantage benefits, like OTC cards and giveback benefits. This means making sure your preferred doctors are in network and your prescriptions are covered.

Carrier-specific OTC benefit information

As we mentioned throughout this piece, a lot of the details about OTC benefits are specific to the Medicare Advantage plan you have and the insurance company that offers that plan.

That’s why we built the My OTC online shopping experience. With a few clicks, you can see your plan’s OTC catalog, browse eligible products, and place an order for free delivery to your home. Check it out and get free delivery today.

For more details on how the most common carriers handle OTC benefits, read these guides:

FAQs

Does Original Medicare or Medigap offer an OTC benefit?

No. Only Medicare Advantage plans provide OTC allowances as an extra benefit.

Do OTC benefits expire?

Yes. Most OTC benefits are provided monthly, quarterly, bi-annually, or annually. Some do roll over, but most expire and reset at the end of their benefit period.

Do OTC benefits cover groceries and utilities?

Some OTC benefits for Special Needs Plans can cover groceries and utilities. These benefits vary widely, so check your OTC catalog or explanation of benefits to confirm.

What should you do if your OTC card is declined?

Verify the store you're shopping at participates in the plan network
Check that the exact item is eligible
Confirm that your card has been activated
Check your remaining balance
Ask whether split payment is permitted
Save your receipt and call the number on the card