unitedhealthcare® medicare advantage assure how much pay for over the counter drug benefits

by Melissa Torp Published 2 years ago Updated 1 year ago

Unfortunately, Original Medicare does not cover the cost of over-the-counter health products. Meaning you, the beneficiary, are responsible for 100% of the cost for things like cold and flu medicine, Band-Aids, etc. So, if over-the-counter coverage is important to you, you will need to enroll in a Medicare Advantage plan.

Full Answer

What are the benefits of UnitedHealthcare Medicare Advantage plans?

All UnitedHealthcare Medicare Advantage plans offer ways to help members to connect to the care they need. Plan benefits and features may include help finding a doctor, getting a ride to appointments, or talking to a nurse 24/7. UnitedHealthcare offers many different Medicare Advantage (Part C) plans.

Do Medicare Advantage plans cover over-the-counter medications?

This opened the door for Medicare Advantage plans to begin including coverage for things such as over-the-counter medication allowances as part of their benefit lineup. Some of the other newly expanded Medicare Advantage benefits include (but aren’t limited to) things like:

Can I appeal a UnitedHealthcare Medicare Advantage plan decision?

UnitedHealthcare Medicare Advantage Plan members have the right to appeal benefit decisions in accordance with Medicare guidelines as outlined in the UnitedHealthcare Medicare Advantage Plans EOC or SOB.

Why are more Medicare Advantage beneficiaries enrolled in OTC plans?

In 2019, more than 51 percent of Medicare Advantage beneficiaries were enrolled in a plan with OTC benefits. 1 This is due in part to the Centers for Medicare and Medicaid Services (CMS) giving Medicare Advantage plan carriers more flexibility in the benefits that Medicare Advantage plans can offer. This move was designed to:

Does UnitedHealthcare cover over-the-counter drugs?

Over-the-Counter (OTC) Many non-prescription, over-the-counter (OTC) drugs, medicines and medical care items are considered eligible for reimbursement under health care Flexible Spending Accounts (FSA) and Definity / iPlan Health Reimbursement Accounts (HRA).

What is UnitedHealthcare OTC benefit?

What is the benefit? The OTC benefit offers you an easy way to get generic over-the-counter health and wellness items by going to any OTC Health Solutions-enabled CVS Pharmacy, CVS Pharmacy y mas, or Navarro store. You can also order by phone at 1-888-628-2770 (TTY: 711) or online at https://www.cvs.com/otchs/uhc.

What Store Can I use my UnitedHealthcare OTC card?

You can use your OTC card for covered items at participating local retailers, including:CVS.Walgreens.Duane Reade.Rite Aid.Dollar General.Family Dollar.Walmart.

Can a patient have a supplement with Medicare Advantage?

Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage.

Does Medicare cover over the counter drugs?

Generally, your Medicare drug plan only covers prescription drugs and won't pay for over-the-counter drugs, like aspirin or laxatives. Your Medicare drug plan will only cover prescription drugs that are on its formulary (drug list), unless it's covered by an exception.

How do I get money on my OTC card?

Simply complete eligible healthy activities like an annual wellness visit, certain screenings or participating in a qualifying health program. Rewards you earn will be automatically added to your OTC plus Card, with no forms to fill out.

How do I activate my UnitedHealthcare OTC card?

How do I activate my card? Before you can use your card, you must activate it. If you haven't done so, call 1-866-755-2648 and just follow the directions. One phone call will activate all cards (all participants are sent two).

How do I use my UnitedHealthcare OTC card at Walmart?

In-Store: Using your OTC card as your preferred payment option at Walmart stores is pretty simple. Just present your OTC card during checkout and the cashier will process your payment. Note that not all OTC card programs are not accepted in stores purchases and can only be used to purchase items online.

How does OTC network card work?

At the beginning of each calendar quarter, your OTC card is loaded with the quarterly OTC amount for your plan. Your balance does not carry over—try to spend the full amount before the end of each quarter. Don't throw out your card—it will be reloaded at the start of the next calendar quarter.

What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

What is the difference between supplement and Advantage plans?

There are two options commonly used to replace or supplement Original Medicare. One option, called Medicare Advantage plans, are an alternative way to get Original Medicare. The other option, Medicare Supplement (or Medigap) insurance plans work alongside your Original Medicare coverage.

When can you add a Medicare Supplement to a client with a Medicare Advantage plan?

Can I combine Medicare Supplement with Medicare Advantage? If you already have Medicare Advantage plan, you can generally enroll in a Medicare Supplement insurance plan under one condition – your Medicare Advantage plan must end before your Medicare Supplement insurance plan goes into effect.

Health Care Services and Medical Supplies

UnitedHealthcare Medicare Advantage Assure (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Prescription Drug Costs and Coverage

The UnitedHealthcare Medicare Advantage Assure (HMO) plan offers the following prescription drug coverage, with an annual drug deductible of $480 (excludes Tier 1) per year.

What are the benefits of Medicare Advantage?

Some of the other newly expanded Medicare Advantage benefits include (but aren’t limited to) things like: 1 Non-emergency transportation services (such as trips to the doctor’s office) 2 Caregiver support 3 Home remodeling for aging in place (such as adding bathroom grab bars) 4 Some home-based palliative care 5 Home meal delivery

What percent of Medicare beneficiaries are OTC?

In 2019, more than 51 percent of Medicare Advantage beneficiaries were enrolled in a plan with OTC benefits. 1. This is due in part to the Centers for Medicare and Medicaid Services (CMS) giving Medicare Advantage plan carriers more flexibility in the benefits that Medicare Advantage plans can offer. This opened the door for Medicare Advantage ...

What drugs does Medicare not cover?

Which drugs are not covered by Medicare? Medicare Part A and Part B typically do not cover the following over-the-counter drugs: Vitamins and minerals (except prenatal vitamins and fluoride preparations, in certain situations) Drugs used only for the relief of a cold or cold symptoms.

Does Medicare Advantage cover OTC?

As it turns out, some Medicare Advantage (Medicare Part C) plans may provide allowances for OTC drugs and other products. Medicare Advantage plan availability and benefits may vary, depending on where you live and the plan you have. A licensed insurance agent can help you compare Medicare Advantage plans in your area that may provide coverage ...

Does Medicare cover prescriptions?

Original Medicare (Part A and Part B) doesn’t typically cover prescription medication. If it does, it’s in only limited circumstances. So do Medicare beneficiaries have any options for coverage of over-the-counter (OTC) medications? As it turns out, some Medicare Advantage (Medicare Part C) plans may provide allowances for OTC drugs ...

Does Medicare cover hair growth?

Drugs used for cosmetic purposes or hair growth. Prescription drugs that fall into the above categories may be covered by Medicare if they are being prescribed to treat other conditions and are ordered by your doctor. Speak with your health care provider for Medicare coverage information.

Does Medicare Advantage offer home delivery?

Some Medicare Advantage plans may also offer home delivery of over-the-counter drugs. The exact OTC allowances and other benefits of Medicare Advantage plans may vary. Some Medicare Advantage plans feature $0 premiums, though these types of plans may not be available where you live.

What is a Medicare coverage summary?

The Coverage Summaries are based upon: (1) Medicare publications relating to coverage determinations; (2) laws and regulations which may be applicable to UnitedHealthcare Medicare Advantage Plans; and (3) research, studies and evidence from other sources including, but not limited to, the U.S. Food and Drug Administration (FDA).

Who makes medical necessity determinations?

Medical necessity determinations must be made by trained and/or licensed professional medical personnel only . UnitedHealthcare Medicare Advantage Plan members have the right to appeal benefit decisions in accordance with Medicare guidelines as outlined in the UnitedHealthcare Medicare Advantage Plans EOC or SOB.

Does United Healthcare make medical decisions?

UnitedHealthcare does not practice medicine and does not make medical decisions for UnitedHealthcare Medicare Advantage Plan Members. Medical decisions for UnitedHealthcare Medicare Advantage Plan Members are made by the treating physician in conjunction with the member.

Does United Healthcare have to apply the medical review policies of the contractor?

In cases where services are covered by UnitedHealthcare in an area that includes jurisdictions of more than one contractor for original Medicare, and the contractors have different medical review policies, UnitedHealthcare must apply the medical review policies of the contractor in the area where the beneficiary lives.

What are the benefits of UnitedHealthcare?

What are the benefits of Medicare Advantage plans from UnitedHealthcare? All UnitedHealthcare Medicare Advantage plans offer ways to help members to connect to the care they need. Plan benefits and features may include help finding a doctor, getting a ride to appointments , or talking to a nurse 24/7. Find a Medicare Advantage plan that may be right ...

What does Medicare Advantage cover?

What do Medicare Advantage (Part C) plans cover? Medicare Advantage plans are required to offer all the benefits included in Original Medicare (except hospice care which continues to be covered by Part A). These plans combine coverage for hospital (Part A) and doctor (Part B) visits all in one plan. Many Medicare Advantage plans also include ...

Does Medicare Advantage include prescriptions?

Many Medicare Advantage plans also include prescription drug coverage (Part D). You may also find plans that offer additional benefits like routine eye and dental care coverage not offered by Original Medicare.

What is Medicare Advantage over the counter?

What is the Medicare Advantage Over the Counter Drug Card? A Medicare Advantage over the counter drug card is a prepaid card for products. You can use your card to buy most health products, as well as medications. Your insurance carrier is in charge of reloading your card each month. Most major retail stores accept these cards, ...

Do pharmacies accept OTC cards?

Different pharmacies and stores can provide you with the over-the-counter products you need. Most major pharmacies and stores accept OTC drug cards, but of course, will vary.

Does Medicare Advantage cover over the counter drugs?

Medicare Advantage policies will often partner with large retail pharmacies. By doing this, it enables people to use over the counter benefits with their drug card. Some plans even include home delivery of your over the counter drugs. Your drug card balance and benefits will vary depending on your specific plan.

Can I get an OTC card without Medicare?

Can I Get an OTC Drug Card Without Medicare Advantage Coverage? Unfortunately, Medicare doesn’t cover the cost of your over the counter health products. Which means you’ll have to pay for things such as cold and flu medicine. But if you decide that you need help covering over the counter medications, you can buy a Medicare Advantage plan. ...