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) items. Certain brands are included in these categories:
- Acid controllers, both liquids and tablets
- Adult aspirin and other pain relief medicines
- Allergy and/or sinus medicines, both liquids and tablets
- Bathtub safety accessories
- CoQ10 only (UBIQUINOL)
- Cough, cold, and flu medicines, both liquids and tablets
- Denture/dental care (floss, toothbrushes, toothpaste, and denture care)
- Ear drops and eye wash
- Elevated toilet seats and accessories
- Foot care (corn/callus/bunion pads and removers, anti-fungal powders/creams/liquids/sprays)
- Grab bars and handles
- Grooming and dressing aids
- Heart health and essential fatty acids (fish oil, flax, gamma linolenic acid (GLA), etc.)
- Handheld showers
- Instant hand sanitizer
- Incontinence supplies
- Laxatives (stool softeners and fiber acid)
- Masks (respiratory, barrier, etc.)
- Mobility safety: stair rails, stair treads, temporary mobility ramps
- Protective gloves
- Sitz baths and bidets
- Vaporizers, humidifiers, and accessories
- Vitamins and minerals
Please note the product list is subject to change. Items, quantities, sizes, and brands change depending on availability at the retailer.
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)
- Meal-replacement shakes/nutrition drinks (Ensure, Boost, and Glucerna)
- Oral care (mouthwash and breath remedies)
EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Select (HMO D-SNP), and EmblemHealth VIP Dual Reserve (HMO D-SNP) plan members receive an OTC card with up to $155 per month, depending on the plan and where you live.
Here are ways to order your items once you activate your card:
Call NationsOTC at 844-432-4327 (TTY: 711),
Monday to Friday, 8 am to 8 pm
EmblemHealth VIP Reserve (HMO) plan members receive $15 per month and can get covered OTC items by mail-order only.
Here are ways to order your items:
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, NationsOTC will ask you 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 call EmblemHealth Medicare Connect Concierge 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.
Last Updated 07/28/2021
Y0026_200570 Accepted 9/29/20
