The common cold is a nuisance and can sometimes keep you from your normal activities. Medications to reduce your symptoms are available at the pharmacy, but you may wonder if your Medicare health insurance helps cover the costs.
Over-the-counter (OTC) drugs and health care products are becoming more and more popular in this country, and sales topped 162 billion dollars in the United States in 2022. Today, seniors make an average of 26 trips to retail outlets per year solely for OTC purchases like cold care products, vitamins, pain relievers, and many others. Unfortunately, Medicare coverage usually doesn’t apply for these products and you must pay for them out-of-pocket.
Many Medicare Advantage plans have added coverage for over the counter products in an attempt to meet your needs. As of 2023, 87 percent of all Medicare Advantage (MA) plans now offer OTC benefits. Because private insurance providers realize that Medicare beneficiaries are interested in having OTC allowances, most now offer them as part of their coverage. If you are new to Medicare or thinking about switching plans, compare the MA plans in your area.
Does Medicare cover over-the-counter cold medicine?
If you’re enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance) you may also have a stand-alone Part D Prescription Drug Plan (PDP). If you do, your Part D provider might cover prescribed cold medications, but only if your health care provider has prescribed them as medically necessary to treat another illness or condition such as asthma or shortness of breath.
Most Medicare Advantage plans include prescription drug coverage. Since they’re offered by private companies, plans can choose the amount of OTC coverage offered and may provide enrollees with an annual or monthly OTC allowance. You can use these benefits to buy certain non-prescription and health care products from certain stores or online retailers. Your MA plan should provide you with a catalog of which products you can purchase and what stores you can use. Depending on the plan you enroll in, you may have to use suppliers, providers, and pharmacies within the plan’s network.
What products you can purchase with your OTC benefit card depends on what your plan permits, but most include the following types of products:
- Cold medicine
- Cough syrup or lozenges
- Flu medicine
- Antibiotic ointments
- First-aid products
- Denture care products
- Orthopedic support items
- Pain relievers
- Medications to aid digestion
- Sleeping aids
- Wart removal products
You can only use your OTC allowance card at national retail stores that your Medicare Advantage plan works with. Major chain stores like CVS, Target, Walgreens, Walmart, etc. are very likely to accept Medicare OTC cards, but you should check your plan policy before shopping for OTC products to ensure that they accept your plan’s card. If you aren’t sure which stores will accept your card, be sure to contact your provider for details before making a purchase with your Medicare OTC card.
How much does OTC cold medicine cost without Medicare insurance coverage?
With hundreds of OTC cold medications available on the market today it’s difficult to give an accurate cost. What you pay for your cold remedy depends on the type of medication, what symptoms it relieves, the brand, the store, and the amount of product you get. Today in the United States, the national average cost for a basic OTC cold medicine is between $5 and $20 without a store coupon or insurance coverage.