What’s the Difference Between an OTC and Grocery Benefit?

• Admin
• 25 Jan 2025

What’s the Difference Between an OTC and Grocery Benefit?

If you’ve been struggling to afford groceries or over-the-counter (OTC) 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, Medicare Advantage plans often offer additional benefits.

Most Medicare Advantage (MA) plans provide a variety of extra services, including prescription drug coverage, hearing aids, dental and vision care, and wellness programs. Many also include an OTC allowance. This allowance typically comes in the form of a pre-paid card issued monthly or quarterly that can be used at local pharmacies for approved OTC medications, wellness items, and personal care products.

Since MA plans are provided by private insurers, the costs and benefits can vary. When comparing plans, be sure to review all potential expenses—including premiums, copayments, and deductibles—and confirm that the plan covers your preferred doctors and necessary medications. If you want to switch to a plan with an OTC allowance, weigh all costs and benefits carefully.

Do You Qualify for a Grocery Benefit?

While many MA plans offer an OTC benefit, grocery benefits are typically included only with Medicare Advantage Special Needs Plans (SNPs). These plans are designed for individuals with specific health or living situations and have eligibility requirements.

Types of Special Needs Plans

• Chronic Condition Special Needs Plans (C-SNPs): For individuals with chronic conditions like cancer, diabetes, or dementia.
• Institutional Special Needs Plans (I-SNPs): For individuals living in an institution, such as a skilled nursing facility.
• Dual-Eligible Special Needs Plans (D-SNPs): For individuals who qualify for both Medicare and Medicaid. These plans often include extra benefits such as grocery allowances.

What to Expect with a Grocery Benefit

Medicare Advantage plans that offer a grocery benefit usually provide a prepaid food card that can be used at participating local grocery stores. This card allows eligible members to buy healthy foods, such as fruits, vegetables, meat, dairy, and whole grains. Items like alcohol, sugary or heavily processed foods, and non-food products are typically excluded from coverage.

It’s important to review the list of participating grocery retailers and ensure your intended purchases fall within the covered items of the plan’s food allowance. This benefit is aimed at improving access to nutritious food for people with chronic conditions or limited financial resources.