Medicare Advantage

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Medicare

Today, over 11 million Medicare Advantage plan members are eligible for OTC Medicare benefits, potentially representing $5.5 billion annually.1 However, the majority of Medicare Advantage plan members must either go out-of-pocket to pay for OTC items and seek reimbursement, or order online via catalog and wait 5-7 days to receive OTC items. This lack of immediate access to OTC benefits, results in less than 5% of the $5.5 billion in OTC Medicare benefits being consumed annually, costing tens of billions of dollars in unnecessary doctor and hospital visits that result from patients seeking care for less serious ailments treatable with OTC medications, or for ailments that go untreated and later require urgent care.

OTCNetwork™ is the first national OTC benefits disbursement and redemption network for Medicare Advantage plans and their members, and addresses current cost challenges Medicare Advantage plans face. OTCNetwork enables Health Plans offering Medicare Advantage benefits to provide more efficient consumer access to and use of OTC item benefits for use in self-care. Medicare Advantage plans load monthly OTC Medicare benefits onto OTCMedicare™ branded, re-loadable prepaid cards, which plans distribute to their members. Medicare Advantage plan members can then access their benefits via participating retailers nationally using their OTCMedicare prepaid card, which restricts spend to the purchase of OTC Medicare eligible items only for use in self-care. Increasing member overall health and self-care through OTC items dramatically reduces healthcare costs, and increases member satisfaction and re-enrollment rates.

OTCNetwork features patented technology with acceptance integrated into front-of- store, point-of-sale terminals at over 45,000 retail locations in all 50 states, including Puerto Rico. Our OTC Supplemental Benefit cards are prepaid, health plan-branded, and re-loadable, restricting spend exclusively to CMS-approved items.

To find out how your organization can offer the OTCMedicare branded prepaid card to your Medicare Advantage members, Click here.

1Klees, Barbara S. and Wolfe, Christian J. et al. Brief Summaries of Medicare & Medicaid: Title XVIII and Title XIX of The Social Security Act. November 1, 2010; p.8.

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