Over the Counter (OTC) Benefits

OTCAs a member of EmblemHealth VIP Dual (HMO SNP), you will get an OTC Medicare card with a monthly benefit up to $125 depending on where you live when you enroll in the plan. As a member of the EmblemHealth Affinity Medicare Ultimate (HMO SNP) , you will get an OTC Medicare card with a monthly benefit up to $60 when you enroll in the plan. You can use this card to buy covered items from any OTC pharmacy we contract with. Please review list of covered items below.

Please note that not all OTC items are covered. Your card will only work for covered items.

How to buy your OTC item(s):

To get your OTC item(s), take your card and your covered OTC item(s) to the checkout at any store or pharmacy in the OTC network. The amount you spend will be taken out of your monthly benefit. Your left-over balance will show at the bottom of your receipt. Any leftover balance will carry over until your next purchase. You must use the entire balance on the card before the end of each month. On the first day of each month your balance will be reset.

Participating stores:

You can use the card to pay for covered OTC items at participating stores, including Duane Reade, CVS, Rite Aid, Walgreens and Family Dollar. Other stores are available in the network.

If you are an EmblemHealth VIP Dual (HMO SNP), or EmblemHealth Affinity Medicare Ultimate (HMO SNP) member, call 877-344-7364 (TTY: 711) for help finding a participating store.

For card balance:

Please call 888-682-2400 and enter your OTC Medicare card number listed on the front of your card and your plan member ID located on the front of your EmblemHealth VIP Dual (HMO SNP), or EmblemHealth Affinity Medicare Ultimate (HMO SNP) member ID card. You can also check your balance at otcmedicare.com.

Our plan covers some OTC drugs in these categories:

Covered items

  • Acid controllers, liquids and tablets
  • Adult aspirin, and pain relief
  • Allergy, sinus and combination liquids and tablets
  • Bathtub safety and accessories
  • CoQ10 only (UBIQUINOL)
  • Cough, cold and flu liquids and tablets
  • Denture/dental care (floss, toothbrush, toothpaste, and denture care)
  • Digestive aids (probiotics and prebiotics)
  • Ear drops and eye wash
  • Elevated toilet seats and accessories
  • Foot care (corn/callus/bunion pads and removers, anti-fungal powders/creams/liquids/sprays)
  • Hand held showers
  • Grab bars and handles
  • Grooming and dressing aids
  • Heart health and essential fatty acids (fish oil, flax, Gamma Linolenic Acid (GLA), etc.)
  • Incontinence supplies
  • Laxatives (stool softeners and fiber acid)
  • Mobility Safety: Stair rails, stair treads, temporary mobility ramps
  • Sitz baths and bidets
  • Vaporizers, humidifiers and accessories
  • Vitamins and minerals
EmblemHealth VIP Dual (HMO SNP) and EmblemHealth Affinity Medicare Ultimate (HMO SNP) Over-the-Counter (OTC) Covered Drugs and Items

Our plan does not cover OTC drugs in these categories:

Non-Covered Items

  • Herbals and botanicals - (example echinacea- ginsenge-ginko giloba)
  • Foot care (foot grooming, foot moisturizers, exfoliators & cleansers, odor and wetness treatment insoles/inserts)
  • Liquids and powders and bars
  • Meal replacement shakes/nutrition drinks (Ensure, Boost and Glucerna)
  • Oral care (mouthwash and breath remedies)
  • Sport/energy liquids
  • Weight management foods

How to get reimbursed:

If you forget to bring your card with you to the store or pharmacy, you may also ask for a refund using a paper claim form.

After you pay for the OTC item(s), 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 then refund you for the covered OTC item(s) and take off that amount from your current debit card balance.

If you have any questions, please call Customer Service at 877-344-7364 (TTY: 711), 8 am to 8 pm,  seven days a week. Customer Service has free language translator services available for non-English speakers.

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