Over-the-Counter FAQs | L.A. Care Medicare (2024)

FAQs

Does L.A. Care cover OTC? ›

L.A. Care Medicare Plus (HMO D-SNP) members have access to a $180 quarterly (every 3 months) allowance to spend on over-the-counter (OTC) health items. The $180 quarterly allowance is loaded on your Mastercard® Prepaid Card every three months. Use your Mastercard® Prepaid Card to buy items in-store.

Use your $25 a month to get items like baby wipes, allergy products, pain relief medicine and more. You can also get everyday items like laundry detergent, soap and toothbrushes.

Your Benefits Prepaid Card can be used to purchase eligible OTC items at participating retail stores in-person. You can also order products online, by phone, or by mail exclusively through our OTC partner, NationsBenefits, and get them delivered to your home at no additional cost.

You can use your card to buy things like: Food and fresh groceries, like meat, vegetables, and canned goods. Everyday items, like toothpaste, shampoo, deodorant and shaving cream. Household goods, like laundry detergent, paper towels and tissues.

What does the OTC card not cover? A Medicare plan with an OTC allowance typically does not cover prescription medications, alcohol, tobacco products, cosmetics or items for general household use. Additionally, it usually cannot be used to purchase gift cards or pay for services such as doctor visits and lab tests.

Your OTC benefit helps you save money on a wide range of over-the-counter health and wellness products. You can use your benefit amount to purchase products such as pain relief, first aid, cold and allergy medicine, dental care items and more. Check your OTC catalog for the list of items covered by your benefit.

This benefit provides you with a quarterly allowance to order eligible over-the-counter medications and health-related products. OTC medications are trusted as a first line of defense in treating minor ailments, help reduce doctor visits and save you money.

Often, these contracts are on a utilization basis where the health plan incurs costs when the benefits are utilized by enrollees. OTC is one of the most popular Supplemental Benefits. It is offered in nearly 80% of all Medicare plans offered and, as of 2021, nearly 18 million MA enrollees had access to an OTC benefit.

How do I check the balance on my OTC card? Once your card is activated, you should learn how to check your account details. You'll especially need to check your balance and the amount you've used. Most cards have a toll-free number listed on the back of the card, which you can call to find out.

Items that do not qualify include non-food and pet items, alcohol, baby formula, candy, chips, coffee shop items, desserts, fresh baked goods, soda, and tobacco. To check if an item is approved, members can download the Healthy Benefits Plus app, scan the product and it will advise if item is allowable.

What foods can you get with OTC? ›

Examples of approved food items are fruits, vegetables, meats, poultry, seafood, eggs, dairy, rice, pasta, beans, and much more.

You can also ask for cash back. Use a HigherOne ATM to withdraw funds. $500 withdrawal limit per day.

Most of the prescription drugs you get from a pharmacy are covered by the plan. Other drugs, such as some over-the-counter (OTC) medications and certain vitamins, may be covered by Medi-Cal Rx. Please visit Medi-Cal Rx website (www.medi-calrx.dhcs.ca.gov) for more information.

L.A. Care covers health services provided in your home, when prescribed by your doctor and found to be medically necessary. L.A. Care covers hospice care and palliative care for children and adults, which help reduce physical, emotional, social and spiritual discomforts.

Blue Shield of California offers an over-the-counter (OTC) items benefit which covers OTC health and wellness products, including first-aid supplies, pain relievers, cough and cold medicines, and more. This benefit includes a quarterly allowance.

L.A. Care Members can use MinuteClinic® retail clinics located in CVS Pharmacy stores as an option for care.