2022 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.
  • 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):

  • 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.
  • Herbals and botanicals (echinacea, ginseng-ginkgo biloba)
  • Foot care (foot grooming, foot moisturizers, exfoliators and cleansers, odor and wetness treatment, insoles/inserts)
  • Weight management (nutritional drinks, sports and energy drinks, meal replacement, foods – liquids, powders, and bars)
  • 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

OTC items by mail order

OTC items in retail stores

OTC items and healthy foods

OTC card

EmblemHealth VIP Dual (HMO D-SNP)

EmblemHealth VIP Dual Reserve (HMO D-SNP)

EmblemHealth VIP Dual Select (HMO D-SNP)

 

EmblemHealth VIP Reserve (HMO)

 

 

 

EmblemHealth VIP Rx Saver (HMO) 

 

 

 

 

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, EmblemHealth VIP Dual Reserve and EmblemHealth VIP Dual Select 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.

*EmblemHealth VIP Dual Select members do not have an OTC food option.

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 & 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 at gafoods.com/emblemhealth or call 888-446-2836 (TTY: 711) for healthy food and produce; or
  2. FarmBoxRx, online at farmboxrx.com/emblemhealth or call 888-416-3589 (TTY: 711) for fresh food box choices include mixed produce, all vegetable, and diabetic choices.

*EmblemHealth VIP Dual Select, EmblemHealth VIP Reserve, and EmblemHealth VIP Rx Saver members do not have an OTC food option.

How to Get Your Eligible Items Once You Activate Your OTC Card:


At participating retail locations, including CVS, Rite Aid, Walgreens, Walmart, and many others. Check participating locations at otcnetwork.com or call Connect Concierge and we will find a location near you.


Retail list of covered OTC items 

English   Español   中文

 

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

 

List of covered OTC items by mail, phone and online and mail order form

Download PDF (English)   

 

Visit ConveyBenefits.com/emblemhealth to select your covered items and complete the checkout process.

 

Call ConveyBenefits at 855-858-5940 (TTY: 711),
Monday to Friday, 8 am to 8 pm

EmblemHealth VIP Reserve (HMO) and EmblemHealth VIP Rx Saver (HMO) plan members receive $25 per month and can get covered OTC items by mail order only. 

 

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

 

Visit emblemhealth.com/mailOTC to select your covered items and complete the checkout process.

 

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

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

English  Español

 

Call NationsOTC at 877-239-2942 (TTY: 711), Monday to Friday, 8 am to 8 pm


 

 

Mail-order items should be received in the mail within two to five 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), 8 am to 8 pm, seven days a week.

Last Updated 10/01/2021

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