Many Americans Might Be Missing Out on Medicare Benefits
It seems that millions of Americans enrolled in the Medicare program may be letting billions of dollars in benefits slip through their fingers. These benefits could enable seniors to obtain a range of supplies at no cost.
Individuals participating in the Medicare Advantage (MA) program have access to what are known as “over-the-counter,” or OTC, benefits, according to Dr. Mark Fendrick, a professor at the University of Michigan. A report from the consulting firm Milliman noted that around 87% of MA plans offer some form of OTC benefit.
Why Is This Important?
Understanding these benefits is crucial as they can provide much-needed financial relief for seniors, especially with rising inflation affecting grocery costs, healthcare, utilities, and more.
Data from the Consumer Healthcare Products Association (CHPA) indicates that approximately 18 million Americans have access to OTC benefits, with eligible MA enrollees receiving an average of $400 annually for specific health and wellness products.
What You Need to Know
Shockingly, only about 30% of MA recipients fully utilize their OTC benefits, resulting in nearly $5 billion in unclaimed benefits each year, as stated by CHPA.
These benefits generally cover various non-prescription health products like vitamins, pain relievers, and first aid supplies, along with dental, eye, ear, and foot care products.
Though not every nonprescription item qualifies for OTC benefits, community pharmacies can often serve as a good source, says Lucas Berenbrock, an associate professor of pharmacy at the University of Pittsburgh.
He mentioned that some MA plans might preload a type of debit card with rewards, but added that “some people may not know about the benefits or how to use them.”
It’s crucial for beneficiaries to check their plans to see if their desired purchases are covered. “Eligible items can typically be found on the plan’s website or within the mailed brochure,” noted Fendrick.
Additionally, he pointed out that recipients should be aware of their benefit expiration dates, as many do not carry over into future periods.
Fendrick further remarked that these benefits remain largely underutilized for several reasons, including beneficiaries being unaware of their existence and the inconvenience of using debit cards.
People’s Opinions
According to Berenbrock, tools like online catalogs and mobile apps can aid consumers in identifying covered products. Members should review their plans for an up-to-date list, which can include items beyond mere medications—think canes, braces, vitamins, and even COVID-19 tests. OTC benefits can help alleviate out-of-pocket expenses for these necessary items.
She emphasized the value of community pharmacies for purchasing OTC products, as pharmacists can provide guidance on safe and effective use of non-prescription items. “Consult your local pharmacist before using OTC products to improve your health,” she advised.
What Happens Next?
To assist seniors in accessing their OTC benefits more easily, a free app has been developed called Chapter OTC by Kobi Blumenfeld Ganz.
This app enables seniors to check their in-store balances, identify eligible items available in stores, and even arrange for home delivery of those items.
