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.
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Medicare Over-the-Counter (OTC) Benefit
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.
Visit emblemhealth.com/mailOTC to select your covered items and complete the checkout process.
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:
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 01/01/2023
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