Caregiver's Guide to Medicare OTC Benefits: Ordering for a Loved One

Helping Your Loved One Use Their OTC Benefit

Many Medicare members need help from family caregivers to take full advantage of their OTC benefits. Whether your loved one has mobility issues, cognitive challenges, or simply isn't comfortable ordering online, you can help them get the most from their benefit.

Becoming an Authorized Representative

• Why it matters: To order on behalf of a member, you typically need to be listed as an authorized representative with their insurance plan
• How to set it up: Call the member's plan using the number on their card. Request to add an authorized representative. You'll likely need the member present on the call
• Power of Attorney: If you have healthcare POA, this typically grants access to manage benefits. Send a copy to the insurance company

Ordering Tips for Caregivers

• Keep a list: Maintain a running list of OTC items your loved one uses regularly. Reorder the same items each quarter for consistency
• Order early: Don't wait until the last week of the quarter. Order in the first two weeks when the new allowance becomes available
• Check for changes: Plans sometimes change their OTC catalogs. Verify that previously covered items are still available
• Track the balance: Log into the member portal or call to check the remaining balance before ordering

Managing Multiple Benefits

• OTC vs grocery: If the plan has both, know which items fall under which benefit
• OTC vs pharmacy: Some items (like certain vitamins) may be available through both OTC and pharmacy benefits. Compare costs
• Keep records: Save order confirmations and track what was ordered each quarter for reference

Common Caregiver Challenges

• Member doesn't remember their PIN: Call customer service to reset it. Have the member present if possible
• Card declined in store: Check balance, verify the item is eligible, and ensure the card is activated