OTC insurance benefits much more limited now?

Posted by carbcounter @carbcounter, 3 days ago

I have a Medicare Advantage plan with an Over The Counter (OTC) benefit of $40/quarter, not huge money but nice, that I've used for years for vitamins and whatnot. Just about a year ago there was a change, and most of the stuff I ever used it for before, no longer qualified. Have you seen that too?

I thought it was just my insurance company being cheap but I had a chat with GoogleAI yesterday and it said, "Oh no, Congress thought it was too generous and cracked down on what qualifies!" But I'd have thunk that you'd have heard massive outcries if everyone was seeing what I've been seeing.

So, anybody else have trouble with OTC benefits in 2026?
Thanks.

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I describe my plan's OTC benefit this way:
I'd prefer half the amount in cash.

There's a debit card, but it's not accepted for most OTC stuff I typically buy at Walmart (or wherever). I have no idea why.

Argh.

REPLY
Profile picture for Scott R L @scottrl

I describe my plan's OTC benefit this way:
I'd prefer half the amount in cash.

There's a debit card, but it's not accepted for most OTC stuff I typically buy at Walmart (or wherever). I have no idea why.

Argh.

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@scottrl
But was it much more accepted before June 2025?

I usually spend just enough at CVS that I was effectively using the OTC benefits there. If I had cash I might buy some vitamins elsewhere to save 10-20% so I hear you about that, but not enough to save half.

It wasn't accepted at CVS until about six or seven years ago, first the OTC had to be used on the catalog the insurance company ran online (also in hard copy), and it was very limited. Then they used Walmart to run the catalog for a couple of years - and that was much better! Then it was usable at retail like CVS. And now, it's even more limited than it was back in the beginning.

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Yes, I've definitely noticed it, and have re-named the program Medicare Disadvantage. 😡

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@carbcounter and all - Remember, the "free money" isn't free. The coverage for OTC meds was really a marketing gimmick, to draw people to the Medicare Advantage Plans. Now that all costs are rising, and the amount the companies get from Medicare isn't keeping pace, cuts have to come somewhere.

Stop and think - does the roughly $200 per month you pay for Medicare B plus the premium (if any) you pay for your plan, really even cover your actual medical expenses? When I look at our total annual premiums plus copays, they really don't come close to covering our doctors, labs, tests and scans, surgeries, PT & OT, even without actually being admitted to the hospital! So if they reduce a side benefit instead of raising my premiums, I can live with it.

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Profile picture for Sue, Volunteer Mentor @sueinmn

@carbcounter and all - Remember, the "free money" isn't free. The coverage for OTC meds was really a marketing gimmick, to draw people to the Medicare Advantage Plans. Now that all costs are rising, and the amount the companies get from Medicare isn't keeping pace, cuts have to come somewhere.

Stop and think - does the roughly $200 per month you pay for Medicare B plus the premium (if any) you pay for your plan, really even cover your actual medical expenses? When I look at our total annual premiums plus copays, they really don't come close to covering our doctors, labs, tests and scans, surgeries, PT & OT, even without actually being admitted to the hospital! So if they reduce a side benefit instead of raising my premiums, I can live with it.

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@sueinmn
Actually yes, my Medicare B alone pays what would be out of pocket for my average year. Well maybe not, if I include the dental, even though they only pay about 1/2 to 2/3 of that. I've been a very cheap date for Medicare.

And it's false advertising.

Not to mention the insurance company dings Uncle Sam for thousands per year in my name, just for the base policy.

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Profile picture for carbcounter @carbcounter

@sueinmn
Actually yes, my Medicare B alone pays what would be out of pocket for my average year. Well maybe not, if I include the dental, even though they only pay about 1/2 to 2/3 of that. I've been a very cheap date for Medicare.

And it's false advertising.

Not to mention the insurance company dings Uncle Sam for thousands per year in my name, just for the base policy.

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@carbcounter Not really. They're dinging *us* for thousands each year. The Feds are just the intermediary.

"Zero monthly premiums" -- um, no. Just a transfer of the ~200 bucks a month we're paying anyway.

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Profile picture for Scott R L @scottrl

@carbcounter Not really. They're dinging *us* for thousands each year. The Feds are just the intermediary.

"Zero monthly premiums" -- um, no. Just a transfer of the ~200 bucks a month we're paying anyway.

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@scottrl
Yes, of course, I'm just pointing out the amount on the table here is thousands above and beyond my favorite thing, Part B payments. And they can't seem to give me back $40/quarter in usable form, the whole castle would fall down if they did.

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