What’s the difference between an OTC and grocery benefit?

If you’ve been struggling to afford groceries or over the counter medications, you may be wondering if Medicare can help cover those expenses. While Original Medicare Part A and Part B only cover medically necessary hospital and medical services and supplies, respectively, Medicare Advantage plans usually offer additional benefits.

Most Medicare Advantage (MA) plans offer a wide range of benefits, including prescription drug coverage, hearing aids, dental and vision care, and wellness programs. Most MA plans also include an over-the-counter (OTC) allowance. This benefit usually comes monthly or quarterly as a pre-paid card that can be used at local pharmacies for certain over-the-counter medications, wellness items, and personal care products. 

Since MA plans are offered by private companies, costs and benefits can vary. When comparing plans, take all costs into consideration, including premiums, copayments, and deductibles. Make sure any plans you consider will allow you to visit your preferred providers and give you access to the medications you need. If want to switch to a plan with an OTC allowance, make sure you take all costs and benefits into consideration. 

Do you qualify for a grocery benefit?

While most MA plans include an OTC allowance, grocery benefits are usually reserved for Medicare Advantage Special Needs Plans. In order to qualify for a Special Needs Plan (SNP) you’ll have to meet the enrollment criteria. 

Special Needs Plans cater to Medicare recipients with specific needs or situations:

• Chronic conditions special needs plans (C-SNPs) are offered for individuals with certain chronic conditions, such as cancer, diabetes, and dementia. 
• Institution special needs plans (I-SNPs) provide healthcare coverage for individuals living in institutions, such as a skilled nursing facility. 
• Dual-eligible special needs plans (D-SNPs) provide benefits tailored for dual-eligibles. If you qualify for both Medicare and Medicaid you may be able to enroll in a D-SNP if one is available in your area.

Many C-SNPs and D-SNPs include a grocery store benefit. 

What to expect with a Medicare Advantage Special Needs Plan food allowance

Plans with a grocery allowance will usually offer a prepaid food allowance card that can be used at certain local grocery stores. It can be used to purchase healthy food items, such as meat, vegetables, fruit, and dairy items. The purpose of the food allowance is to make sure people with chronic conditions or limited resources pay for nutritious foods. Sugary and processed foods, alcohol, and non-food items may be excluded from the allowance benefit.

Check your plan’s list of participating retailers and the items covered by the food allowance.