An Over-the-Counter (OTC) card is a prepaid benefit card provided to members of certain Medicare Advantage (Part C) plans. Funded by the health plan, it offers a set allowance to purchase specific health and wellness products without a prescription. The benefit is designed to make managing chronic conditions and general health more affordable by covering the costs of necessary non-prescription supplies.
What OTC Cards Are Designed to Cover
Product eligibility for OTC card purchases is governed by strict regulatory guidelines set by the Centers for Medicare & Medicaid Services (CMS). These rules are modeled after the IRS definition of “qualified medical expenses,” which must be for the diagnosis, cure, mitigation, treatment, or prevention of a disease or illness. The product must serve a medical purpose rather than general health or personal convenience.
OTC funds are primarily directed toward supplies that actively treat or monitor a health condition. Approved categories typically include non-prescription medications, first aid supplies, and monitoring devices. These items are considered necessary to manage health issues such as pain, allergies, or minor injuries.
Toilet Tissue and OTC Eligibility: The Specific Answer
Standard toilet tissue is generally not an eligible purchase with an OTC card because it is classified as a common household item used for general hygiene. The regulatory standard requires an item to be primarily for the mitigation or treatment of a medical condition, which standard toilet paper does not meet. This lack of a specific therapeutic function prevents its inclusion as a qualified medical expense.
The distinction becomes important with specialized products. Medicated wipes intended for hemorrhoid treatment, for example, are typically eligible because they contain active medicinal ingredients. Similarly, specialized wet wipes or personal cleansing cloths may be covered if approved for use with a covered condition, such as adult incontinence. Eligibility hinges on whether the product’s primary function is therapeutic rather than routine hygiene.
Commonly Approved Personal Care and Hygiene Items
While standard toilet tissue is ineligible, many related personal care and hygiene products that serve a medical or preventative function are covered. These supplies are considered medically necessary because they alleviate symptoms or aid in health maintenance.
Eligible items often include:
- Incontinence pads and adult diapers.
- First aid materials, including adhesive bandages, gauze, and antiseptic wipes.
- Oral hygiene supplies like toothpaste and dental floss.
- Certain feminine hygiene products.
- Health monitoring devices such as blood pressure monitors and compression stockings.
Using Your OTC Card: Retailers and Transaction Rules
The practical use of the OTC card is limited to an approved network of participating retailers, such as major pharmacy chains, certain grocery stores, and online vendors. The health plan determines which retailers accept the card, and this list can vary significantly between plans. Cardholders must confirm their plan’s specific list of authorized locations before attempting a purchase.
OTC cards operate using an inventory control system at the point of sale. When the card is swiped, the system automatically identifies and pays only for eligible products. If a transaction includes ineligible general merchandise, the card will decline payment for that portion, requiring the cardholder to use a separate form of payment. Funds are generally provided as a monthly or quarterly allowance and typically expire at the end of that period, as they do not roll over. Many plans provide a dedicated app or online portal where users can check their current balance and view participating store locations.