US · guidance
CMS Pub. 100-16, ch. 4, § 40.1
Overview of OTC Benefit
MA plans may offer as a supplemental benefit health-related items and medications that
are: available without a prescription, and are not covered by Medicare Part A, Part B or
Part D. MA plans may never offer as a Part C supplemental benefit an OTC drug or item
that also is covered under Part B or that is paid for under Part D for the plan’s enrollees.
OTC drugs and items that are eligible to be included in a Part C supplemental benefit
must meet our criteria for qualification as a supplemental benefit in section 30 of this
chapter. Detailed information about OTC drugs paid for under Part D may be found in
Chapters 5 and 7 of the Medicare Prescription Benefit Manual, Pub 100-18.
Under Part C, MA plans may cover health-related OTC items such as adhesive or elastic
bandages, and OTC drugs such as antihistamines and analgesics, that meet the criteria as
eligible supplemental benefits under Part C, presented in section 30.1 above.
Medical supplies associated with the administration of insulin, (e.g., alcohol wipes and
syringes) must be paid for under Part D and are not eligible to be covered as a
supplemental benefit.
Since items and drugs that may be covered by the MA plan as supplemental benefits are
for the enrollee, OTC items may be purchased for the enrollee only.
History
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9c1d7aa9f32c035c758ceb49ae9c1b0b3941c985f5d83e94558ff95bd38fe656
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