Using MA and Medicaid OTC Benefits to Support Older Adult Nutrition Health

As the number of older adults enrolled in Medicare Advantage (MA) plans has increased to over 50%, more older Americans than ever before now have access to supplemental Medicare benefits. Supplemental benefits, like vision or dental care, are those offered beyond the benefits covered under traditional Medicare. Coverage of over-the-counter (OTC) products is one of the top 5 supplemental benefits MA plans offer today. In addition, state Medicaid programs are increasingly offering an OTC benefit to their recipients. Did you know OTC products may include oral nutrition supplements (ONS) which can help support older adult nutrition health?

Why This Is Important

Undernutrition or malnutrition has long been a problem for older adults, with up to one in two older adults at risk for or already malnourished. Individuals with malnutrition are more likely to have worse health outcomes, including longer lengths of hospital stay and increased hospital readmissions, as well as greater risk for functional disability, frailty and falling. For older adults in the community, nutrition care including ONS can help improve health and well-being outcomes. This is in part why the World Health Organization recommends oral supplemental nutrition with dietary advice for older adults with undernutrition.

The Role of ONS

ONS provide additional nutrients—including protein and energy—for those who cannot meet their nutrition needs with food alone. There is evidence that specialized ONS along with dietary counseling provided to community-living older adults at risk of malnutrition can significantly improve nutrition and functional outcomes when compared to a placebo supplement with dietary counseling. ONS can be used in addition to a regular diet, either along with or in place of a meal. The products come in a variety of flavors, are available over-the-counter without a prescription, and can be found in grocery stores and retail pharmacies nationwide.

Medicare Advantage (MA) and Medicaid OTC Benefits

MA plans are offered by private insurance companies, and Medicare beneficiaries can choose to enroll in an MA plan instead of a traditional Medicare plan. Supplemental benefits are important differentiators among MA plans. Over time, the Centers for Medicare & Medicaid Services (CMS) has expanded the range of health-related supplemental benefits that MA plans can offer. OTC benefits have become popular with MA plans as a supplemental benefit for two reasons: the positive correlation between offering an OTC benefit and an MA plan membership and the potential healthcare savings.

In Contract Year 2023, more than 4 out of 5 (87.8%) of over 5,600 MA plans offered OTC benefits. Medicaid OTC benefits vary by state and depending upon regulations, Medicaid beneficiaries may need a prescription or need to meet other requirements for an OTC product to be covered. Importantly the overwhelming majority of states reportedly offer some form of OTC coverage.

‘The average annual OTC card allowance per MA enrollee is $400, yet an estimated 70% of OTC benefits remain unused each year.’

Both MA’s and Medicaid plans’ coverage of OTC products is typically provided via an OTC card with a pre-determined dollar limit. MA and Medicaid beneficiaries can then redeem the OTC card for certain products either through an MA OTC benefit catalog or at specified retailers. The average annual OTC card allowance per MA enrollee is $400, yet an estimated 70% of OTC benefits remain unused each year. Details regarding the average Medicaid allowance and redemption rates for OTC benefits are not readily available, because Medicaid coverage is managed at the state level and older adults’ OTC cards may reflect a combination of Medicare and Medicaid benefits.

How to Help Older Adults Use OTC Cards to Support Nutrition Health

The major barriers to increased OTC card use are lack of awareness and limited understanding about the benefit. To help address such barriers, advocates offer specific advice about OTC cards, including that MA beneficiaries:

  1. Reach out to their MA plan provider and confirm what OTC products are eligible under their plan and how OTC products should be purchased (such as through an OTC product catalogue or at a designated retailer)
  2. Think ahead and make a plan, decide on what and when to purchase an eligible OTC product and then track the dollars spent, because unused OTC funds often do not “roll over” for later use, and
  3. Ask their healthcare provider for suggestions on specific OTC products that promote health and wellness or help support improved outcomes for a chronic condition they may have.

As you work with older adults, their families and caregivers, you can help remind them to use their OTC card benefit to purchase the OTC products they may need, including ONS to help maintain and improve their nutrition health.

Mary Beth Arensberg, PhD, RDN, LDN, FAND, is director of health policy and programs at the Abbott Nutrition division of Abbott in Columbus, Ohio.