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Medicare Over-the-Counter (OTC) Benefit

OTC
 

When your EmblemHealth Medicare Advantage plan includes the over-the-counter (OTC) benefit, you can get covered for the OTC items below. Your benefit amount and how you get your OTC items and supplies depends on the plan you join.

 

 

Which over-the-counter (OTC) items does EmblemHealth cover?

Our plan covers CMS-approved over-the-counter (OTC) health-related items. Certain brands are included. Eligible health categories include:

  • Allergy, sinus, and combination liquids and tablets.
  • Cough, cold, and flu liquids and tablets.
  • Denture/dental care (floss, toothbrush, toothpaste, and denture care).
  • Elevated toilet seats and accessories.
  • Protective gloves
  • And more!

Our plan does not cover over-the-counter (OTC) items in these categories (note: non-covered items can change):

  • Covid Tests.
  • Diabetes care (blood glucose testing, continuous glucose monitoring devices, insulin, syringes, and delivery systems). Diabetes supplies are covered by your plan as a medical benefit.
  • Foot care (foot grooming, foot moisturizers, exfoliators and cleansers, odor and wetness treatment, insoles/inserts).
  • Non-prescription hearing aids.
  • Oral care (mouthwash and breath remedies).

Please note the product list is subject to change. Items, quantities, sizes, and brands change depending on availability at the retailer.

Take a look at the chart below to find your plan and information on how to use your OTC benefit:

Plan Name

Frequency

OTC items by mail order

OTC items in retail stores

OTC card

EmblemHealth VIP Dual (HMO D-SNP)

Monthly

✓

✓

✓

EmblemHealth VIP Dual Enhanced (HMO D-SNP)

Monthly

✓

✓

✓

EmblemHealth VIP Dual Reserve (HMO D-SNP)

Monthly

✓

✓

✓

EmblemHealth VIP Rx Saver (HMO) 

Monthly

✓

✓

✓

 

See your Evidence of Coverage or Cost Sharing Guide for the OTC amount you get with your plan or call EmblemHealth Medicare Connect Concierge for help. OTC benefits do not include healthy foods. OTC benefit amount must be used within the benefit month and will not roll over.

How to Get Your Covered Eligible Items*

  • Retail Locations

    Shop for covered items at participating retail locations.

    Learn More
  • Home Delivery

    Get covered OTC items delivered to your door with CVS Home Delivery or ConveyBenefits 

    Learn More

Mail-order items should be received in the mail within seven business days from the time of receipt of your order. If the total amount of your order is more than your OTC balance, you will be asked for an alternate method of payment. You can use a credit card online or over the phone, and a check when using mail order.

Items, quantities, sizes, and values may change depending on availability. Items may vary based on the manufacturer and availability. If an item is out of stock, a similar product of equal or higher value will be shipped.

How to get reimbursed:

We ask that you use your benefit in one of the ways listed above. If you are unable, you can request a refund using the below form. Simply mail your completed paper claim form to us with a copy of the receipt(s) for the covered item(s) you bought. We will send you a refund check in the mail.

 

Over-the-counter (OTC) Reimbursement Form:

English   Español  中文 

 

Which over-the-counter (OTC) items does EmblemHealth cover?

Our plan covers CMS-approved over-the-counter (OTC) health-related items. Certain brands are included. Eligible health categories include:

  • Allergy, sinus, and combination liquids and tablets.
  • Cough, cold, and flu liquids and tablets.
  • Denture/dental care (floss, toothbrush, toothpaste, and denture care).
  • Elevated toilet seats and accessories.
  • Instant hand sanitizer
  • Masks (respiratory, barrier, etc.)
  • Protective gloves
  • And more!

Our plan does not cover over-the-counter (OTC) items in these categories (note: non-covered items can change):

  • Covid Tests.
  • Diabetes care (blood glucose testing, continuous glucose monitoring devices, insulin, syringes, and delivery systems). Diabetes supplies are covered by your plan as a medical benefit.
  • Foot care (foot grooming, foot moisturizers, exfoliators and cleansers, odor and wetness treatment, insoles/inserts).
  • Non-prescription hearing aids.
  • Oral care (mouthwash and breath remedies).

Please note the product list is subject to change. Items, quantities, sizes, and brands change depending on availability at the retailer.

 

 

Take a look at the chart below to find your plan and information on how to use your OTC benefit:

Plan Name

Frequency

OTC items by mail order

OTC items in retail stores

OTC items and healthy foods

OTC card

EmblemHealth VIP Dual (HMO D-SNP)*

Monthly

✓

✓

✓

✓

EmblemHealth VIP Dual Reserve (HMO D-SNP)

Monthly

✓

✓

✓

✓

EmblemHealth VIP Rx Saver (HMO) 

Monthly

✓

 

 

 

 

*OTC benefit is  not offered in Bronx, Kings, New York, and Queens counties

See your Evidence of Coverage or Cost Sharing Guide for the OTC amount you get with your plan or call EmblemHealth Medicare Connect Concierge for help. OTC benefit amount must be used within the benefit month and will not roll over.

EmblemHealth VIP Dual** and EmblemHealth VIP Dual Reserve Members

You can use your OTC benefit to buy both covered health items and healthy foods* from any participating OTC store or pharmacy we contract with, online, by phone, or through mail- order. The combined over-the-counter (OTC) health and food benefit allows you to also purchase fresh, nutritious, and healthy grocery items.

**OTC benefit is  not offered in Bronx, Kings, New York and Queens counties

OTC Healthy Food Eligible Items Information

Eligible food categories include:

  • Cereal (hot and cold).
  • Dairy products (milk, cheese, butter).
  • Dry foods (beans, fruit, pasta).
  • Eggs and egg substitutes.
  • Fresh food boxes (mixed produce, all vegetable, diabetic and other choices).
  • Frozen food.
  • Fruits and vegetables.
  • Juice.
  • Meat (poultry, beef, sausage, lunch meat).
  • Rice and whole grains.
  • Soup.
  • And more!

Ways to get healthy food eligible items:

  1. GA Foods, online a gafoods.com/emblemhealth or call 888-446-2836 (TTY: 711) Monday to Friday, 8 am to 8 pm for healthy food and produce; or
  2. FarmBoxRx, online at farmboxrx.com/emblemhealth or call 888-416-3589 (TTY: 711) Monday to Friday, 10 am to 6 pm for fresh food box choices include mixed produce, all vegetable, and diabetic choices.

*EmblemHealth VIP Rx Saver members do not have an OTC food option.

How to Get Your Covered Eligible Items*

  • Retail Locations

    Shop for covered items at participating retail locations.

    Learn More
  • Home Delivery

    Get covered OTC items delivered to your door with CVS Home Delivery (New for 2024!)  or ConveyBenefits 

    Learn More

Here are ways to order your OTC items for your mail order-only OTC benefit:

  • By mail – just fill out and send the mail-order form below to NationsOTC.

    Catalog of covered OTC items by mail, phone and online and mail-order form:

  • Call NationsOTC at 877-239-2942 (TTY: 711), Monday to Friday, 8 a.m. to 8 p.m.

Mail-order items should be received in the mail within seven business days from the time of receipt of your order. If the total amount of your order is more than your OTC balance, you will be asked for an alternate method of payment. You can use a credit card online or over the phone, and a check when using mail order.

How to get reimbursed:

We ask that you use your benefit in one of the ways listed above. If you are unable, you can request a refund using the below form. Simply mail your completed paper claim form to us with a copy of the receipt(s) for the covered item(s) you bought. We will send you a refund check in the mail.

 

Over-the-counter (OTC) Reimbursement Form:

English   Español  中文 

If you have any questions, please see your Evidence of Coverage or Cost Sharing Guide for the OTC allowance amount you get with your plan or call EmblemHealth Medicare Connect Concierge at 877-344-7364 (TTY: 711). From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Saturday. 

Last Updated 10/01/2024

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Also of Interest: 
Pharmacy   |   Delivery & Refills   |   Medicare: Additional Pharmacy Information