Blog

Anthem OTC catalog 2024

The Anthem OTC catalog 2024 provides members of participating plans access to many useful items at no charge with their prepaid Benefits Mastercard.  Plan members have the choice to pick up items in store or have them delivered to their doorstep.

Download a copy of the 2024 Anthem OTC Catalog

Here’s what you can find in the catalog

1. OTC benefit details.
2. Details of all the different ways to shop for OTC items.
3. Eligible items listed by category.

Members can call the number on the back of their Benefits Prepaid card for any assistance they need.  Members can also get answers to their questions by logging into their secure account in the Benefits Pro Portal at MyBenefits.NationsBenefits.com.

Here’s how to create an online account

Access your benefits when it’s convenient for you 24/7 at MyBenefits.NationsBenefits.com

First time users need to create an account visiting the Benefits Pro Portal or using the Benefits Pro mobile app.  Once you are on the Nations Benefits portal, just click the “register” button and follow the prompts from there.

If you need assistance, just call 866-413-2582 (TTY: 711)
Once your portal is set up you can log in and view your spending allowance.  Find participating stores nearby, view and track recent orders and look for eligible products.

How to shop for OTC products

Because there are many ways to shop for OTC products, you can easily find the one that works best for you.

In a participating store

Members can use their Benefits Prepaid Card to purchase eligible OTC products at one of the many participating stores.  TO find a store near you, visit MyBenefits.NationsBenefits.com and enter the area you want to shop in.  You will quickly find a list of local stores.  The OTC catalog provides an instore shopping guide with information on the available items.  You can also find eligible items in your member portal as well as by scanning the UPC code found on any product by using the Nations Benefits Pro app.

Once you finish shopping, place your benefits card into the card reader and choose “credit” when prompted.  You do not need a PIN to use the card.  You r eligible spending amount will apply to the purchase.  If you’re spending more than your available balance, you can use another form of payment to cover the remaining balance.

Have items delivered to your home

Members can order products for home delivery from the NationsBenefits catalog or by going to MyBenefits.NationsBenefits.com search by product type or UPC code.
Selected items are shipped to your home at no cost.

Download a copy of the 2024 Anthem OTC Catalog

Order through the Benefits Pro App

You can download the app either by scanning the QR code you find in the OTC catalog or by going to the App Store or Google Play
Once you have the app downloaded, you can choose the items you want to purchase and follow the instructions to pay and checkout.

Place an order by Phone

Find the items and the items number of the OTC products you want to purchase and call the number on the back of your NationsBenefits card.  Member Experience Advisors will assist you Monday through Friday from 8:00AM until 8PM local time.

To order by Mail

Find the items you wish to purchase and fill out the order form at the back of the OTC catalog.
Send your completed order form to:
NationsBenefits
1700 N. University Drive
Plantation, FL 33322
Mail your completed form no later than 12/20/24 to use your available spending allowance before it expires.

More information

The products in the OTC catalog are subject to change.  In some cases, an item, quantity or size may change depending on availability.  Some items may be added or removed without notice.

Visit our homepage for OTC catalogs from other Medicare carriers

To view more images by this artist, click here

Part D catastrophic coverage

In 2023, when a beneficiary’s out-of-pocket spending for prescription drugs reaches $7,400, they reach the Part D catastrophic coverage level.  If this happens, the beneficiary pays 5% co-insurance for prescriptions covered by Medicare Part D for the rest of the year.

2024 catastrophic cost change

On January 1, 2024, the 5% co-insurance payment in the catastrophic phase will end.  Beneficiaries who reach $8,000 in out-of-pocket spending on Part D prescriptions in 2024 will automatically receive catastrophic coverage.  Medicare Part D plan provider will have to pay 20% of the total drug cost instead of the 15% they paid in the past. Once beneficiaries reach this level, they no longer have to pay either copayments or co-insurance for covered Part D prescriptions for the remaining part of the year.

Learn more about Medicare Part D plans

This updated rule applies to Part D enrollees who do not have an LIS (low-income subsidy).  When a Beneficiary reaches the catastrophic level in Part D coverage. they no longer pay 5% of their prescription costs.  In other words, there is a cap on Part D out-of-pocket spending for enrollees in 2024. the catastrophic threshold is $8,000.

How the catastrophic limit is calculated

The catastrophic limit includes the prescription costs paid out-of-pocket by Part D enrollees, as well as the value of the manufacturers price discount on brands of medications in the coverage gap phase.  In 2024, a Part D enrollee who uses only brand-name drugs and spends about $3,250 out-of-pocket pays no additional amount for their prescriptions.  The remaining part of the $8,000 catastrophic limit is taken from the manufacturer’s price discount for the medications.

What this means for beneficiaries

For beneficiaries who do not qualify for LIS and require expensive medications to maintain their health, annual out-of-pocket costs can be as high as $15,000 annually.  This cost applies to individuals who may take some lifesaving cancer medications.  This cost on top of fighting for their lives adds a terrible amount of stress for them. Once a beneficiary reaches the catastrophic phase, eliminating the 5% coinsurance in 2024 means that Part D enrollees who require high-cost medications covered by Part D can save thousands of dollars.

Click here to watch a quick video about the Part D changes

Changes in costs for Part D plan providers

Due to the end of the beneficiaries required 5% coinsurance payment in the catastrophic coverage phase, Part D plans will have to pay 20% of total drug costs during the catastrophic phase in 2024.  This is 5% over the 15% they currently pay in 2023 and in previous years.

Changes for 2025

CMS is putting a hard cap of $2,000 on out-of-pocket, prescription drug spending in 2025.  They will also end the coverage gap phase (donut hole).  Part D plans will have a greater responsibility for prescriptions in the catastrophic phase and more manufacturer price discounts will be added.  These measures will reduce the liability for Medicare in this phase of coverage.  There will be changes to Part D plan costs as well as manufacturer price discounts in the initial phase of Part D coverage.

Please note: the drug cap does not apply to out-of-pocket costs for Part B prescription drugs.

Medicare scope of appointment rules

The Medicare scope of appointment rules are put in place by CMS.  The SOA (scope of appointment) is a form that clients or potential clients as well as their agent must complete before meeting to discuss Medicare plan options. The scope is mandatory if you are discussing either a Medicare Advantage or Part D prescription drug plan. Although, it is a good idea to collect a SOA before any client meeting to protect both the agent and the client.  The SOA form should be kept no less than 10 years and may be collected either physically, verbally or electronically.

Watch a quick video on the scope of appointment rules for 2024

Verbal scope of appointment

When the pandemic began, it was not advisable to host in-person meetings to discuss coverage options.  Because of this, many appointments took place over the phone.  That lead to the use of verbal scope of appointments which are recorded and saved.  Many carriers offer this option as well as quoting/enrollment tools such as Sunfire and Connecture.

Click here to watch a Sunfire enrollment demonstration on YouTube 

General information about a verbal SOA

• If the client calls the agent (inbound call), the 48-hour rule does not apply.
• The scope is good for 12 months from the date it is signed.  You must complete the appointment within that time or obtain a new scope. The scope is still good if the call drops and the same agent calls the client back.
• If additional benefits are added to the discussion, a new scope is necessary.

How long is a SOA good for

As we mentioned above, a scope of appointment is good for 12 months from the date it is signed. It is important that you discuss only products that were agreed to and included in the scope.  If additional products are added, the beneficiary needs to sign a new scope.

If the client asks about Medicare Advantage plans during the 48-hour waiting period and they had not included them on the original scope, you will need to have them sign a new scope before your discussion.  This will restart the 48-hour waiting period and may move your meeting date out further.  This rule applies to any product regulated by CMS.

Need a SOA – Click here

CMS guidelines

In order to be complaint with CMS, agents need to have their clients complete a Medicare Scope of Appointment form. The 2024 CMS final rule went into effect September 30. 2023 and has added some changes to how agents obtain the SOA.

The SOA rules apply to agents and brokers who discuss Medicare coverage options and plans.  The 48-hour rule was put in place so beneficiaries could avoid the high-pressure sales tactics some agents use.  The 48-hour period provides beneficiaries time to consult friends, relatives or anyone they like to research their options. This time also provides agents time to prepare for the discussion.

Agents are able to contact the beneficiary once the SOA is completed for up to 12 months. It is essentially permission to contact until the meeting takes place.  The beneficiary has the option to opt out annually.

Please note, if the beneficiary does not select a coverage option on the SOA, Medicare requires the agent to avoid discussing that option without a new SOA where the option is clearly selected.

Find out about the proposed CMS rule 4205-P, see how it could affect agents!

Exceptions to the 48-hour rule

If the beneficiary is in the last four days of a valid election period, agents may collect a same-day SOA.

When the beneficiary walks into your office and initiates a conversation about coverage options, agents can take a same-day SOA.  This same rule applies to inbound call initiated by the beneficiary to the agent requesting advice.

How long do you need to keep a SOA

Agents must be able to access the SOA form for ten years. Clients have the right to request a copy anytime within that time frame without any issues.  The SOA can provide help in the event that an issue or dispute occurs.  The Scope is in place to protect the consumer, but it can also protect the agent.

To view more images by this artist, click here

Aetna Medicare OTC catalog 2024

Both current members and anyone considering enrollment in an Aetna MAPD plan should take a look at the benefits in the Aetna Medicare OTC catalog 2024.

Aetna has two separate catalogs for 2024.  The first one is for members of their participating MAPD plans, this catalog is called Over-the-Counter Health Solutions (OTCHS).  There are three ways to order products from the OTCHS.

Download the MAPD OTC catalog 2024

Order in a participating CVS pharmacy

Use the following link to find a participating store:  CVS.com/storelocator.

Please note:  CVS pharmacies inside either Target or Schnucks stores do not participate in the OTCHS program.

1. Look in your OTC catalog to find items you would like to purchase.  It is important to know; only items in the catalog are available to purchase with this plan.
2. Locate products marked with the blue shelf tag in the store.  Prices of in store items may not be the same as the catalog price.
3. Use your benefit at any register.  Tell the cashier you have the OTC benefit and show them your member Id card to verify your eligibility.

Use the OTC Health Solutions app to access OTCHS benefits

Download the app from either the App Store (for apple devices) or from Google Play (for Android devices). Look below for three easy steps to use the app in stores.

1.  Scan the item’s barcode to make sure it is an approved item (eligible items should have a blue tag).
2. When you are ready to check out, show the cashier the digital barcode from your phone.
3. Use the app to check on your remaining benefit balance or get answers to some FAQs.

Order items online

Create an account by visiting CVS.com/otchs/myorder.

1. Click on the create account button and follow the prompts.  Please note:  you will need your member ID, birthdate, zip code and a valid email address.
2. Sign into your account and view your available benefit amount as well as products.
3. Add products to your cart and then click checkout.  Confirm your shipping address, review your items and place your order.
4. You will receive an email with tracking information.  Items will arrive in about 14 days.

Order items over the phone

1. To place an order, call 1-833-331-1573 (TTY:711).
2.   You must enter your birthdate to verify your account.  You will also need to verify your name and address.
3. Please have the code for the items you wish to order.  If the code is A10, just enter the numerical code 10.  After your items is located in the system, you verify it is correct.
4. Once you finish your order, you can review items and submit the order.

The second catalog is for Aetna DSNP plan members:

Download the Aetna DSNP OTC catalog 2024 Nations benefits

The catalog for DSNP members is referred to as Nations Benefits.  There are 3 ways to order items from the Nations Benefits catalog,

order by mail

Members receive an order form in their Nations Benefits catalog.   Fill out the form provided and mail it to: NationsBenefits, 100 N. University Drive, Plantation, FL 33322.

Order online

Go to Aetna.NationsBenefits.com

1. create an account by following the instructions on the page.
2. Once you are logged in, you can search for items, read product descriptions and check your benefit balance.
3. Place items in your cart.
4. You will receive an email so you can track your items.  You should receive your order in about 14 days.

Order by phone

Call 1-877-204-1817 (TTY: 711).   Speak with a member experience advisor from 8AM – 8PM, local time 7 days a week, except for holidays.

Please note: Language support is available if needed.

All beneficiaries should be aware:

Because of the personal nature of the items, there are no returns or exchanges.  Please call OTC health solutions within 30 days of receipt if you receive a damaged item.

To view more images by this artist, click here

Medicare Part D cap

Although Medicare Part D provides catastrophic coverage for high out-of-pocket prescription prices, there is no limit on the total amount beneficiaries pay out-of-pocket annually.  Beneficiaries with high drug costs exceeding the catastrophic level are required to pay 5% of their total drug costs unless they qualify for LIS.  The Inflation Reduction Act 2022 addresses the high cost of prescription drugs for Medicare beneficiaries.  The inflation reduction will reduce the out-of-pocket cost beneficiaries pay for medications and reduce federal government spending.  Some of these cost saving measures include changes to the benefits provided by Medicare Part D. This includes a Part D cap on out-of-pocket prescription costs for Medicare Part D plan enrollees.

The Part D cap makes both PDP plan providers and drug companies pay more of the costs associated with expensive drugs.  Some of this cost usually falls on the beneficiary and the federal government.

Watch a quick video on our YouTube channel about the Part D drug cap

Changes to Medicare prescription drug plans coming in 2024

In order to better understand the changes coming for 2024, we will quickly explain the 4 phases of prescription drug coverage as they are in 2023.

1. Deductible phase – beneficiaries pay 100% of their drug costs.  In 2023 the highest deductible amount is $505, although some plans do not charge a deductible.
2. Initial coverage phase – beneficiaries pay a co-insurance rate of 25% of their prescription costs and their Part D plan pays 75%.  This phase lasts until the costs reach $4,660 in 2023.  Many PDP plans charge co-payments and co-insurance in this phase instead of the standard 25% co-insurance rate.
3. Coverage gap (donut hole) phase – beneficiaries pay 25% of the prescription cost for all covered drugs both generic and name brand.  The PDP plan pays the remaining 75% for generic prescriptions and 5% for name brand drugs while drug manufacturers give beneficiaries a 70% discount for these drugs.
4. Catastrophic phase – In 2023 the catastrophic threshold is $7,400.  Once the threshold is reached, Medicare pays 80% of the drug cost while the PDP plan pays 15% and the beneficiary pays the remaining 5%.

The beneficiary’s costs in the catastrophic phase will change in 2024

In 2024 the 5% coinsurance payment for beneficiaries will be eliminated.  The PDP plans will pay 20% of the drug costs in this phase instead of the 15% they paid in previous years.  The catastrophic threshold in 2024 will be $8,000. The threshold limit includes the amount beneficiaries spend as well as the value of the manufacturers discount on prescriptions in the coverage gap phase.

In other words, there will be a spending cap for beneficiaries who take name brand drugs of about $3,2500 in 2024.  In 2025, there will be a hard cap of $2,000 on out-of- pocket costs for prescriptions.

Beneficiaries can save thousands on expensive medications

Beneficiaries who currently need expensive lifesaving medications to treat serious illnesses can now concentrate on recovering instead of worrying about how to pay the high cost of their medications.

The elimination of the 5% coinsurance spent in the catastrophic phase of Part D coverage will save enrollees thousands of dollars.

Please note:  this program benefits those enrollees who do not receive LIS for the cost of prescription medications.

To view more images by this artist, click here

Scope of appointment 48 hours

As of September 30, 2023, the CMS Final Rule includes a change that includes the requirement of obtaining a scope of appointment 48 hours before an agent meets with a client or potential client.  This is a major change to the current SOA (Scope of Appointment) rules.

The Scope of Appointment also referred to as SOA, is a form that must be signed by a beneficiary before a scheduled meeting.  The form outlines the topics that the agent and beneficiary have agreed to discuss during their meeting. The purpose of the SOA is to discourage agents from pressuring the beneficiary to discuss products they are not prepared to discuss.  This ensures that beneficiaries have time to consider the products they are actually interested in learning about and helps to avoid confusion.

Find out about the proposed CMS rule 4205-P and how it could affect you!

Do you really need to get the SOA 48 hours in advance

The short answer is, YES.  As we mentioned before, this rule applies to scope of appointment forms starting September 30, 2023.  The SOA must be signed 48 hours before a scheduled appointment or phone call with the beneficiary.  The rule is the same weather you are meeting with a client who has been part of your book of business for years or a potential new client.  Anytime you meet to discuss plan benefits, you need a scope of appointment.

Watch a quick YouTube video on the Scope of appointment rules

Exceptions to the rule

There are three exceptions to the 48-hour rule.

1. One exception to the rule is during the last four days of a valid election period.  During this time, agents are permitted to get a same day Scope.
2. The second exception is when the beneficiary walks into the agent’s office without a scheduled appointment. This beneficiary-initiated meeting is referred to as a “walk in”.
3. The third and final exception is when the beneficiary calls the agent without a scheduled appointment time.

Find out about the CMS call recording requirements

How this rule effects the agent

This rule can make things somewhat difficult for agents.  Some beneficiaries may not want to go out of their way to sign a form 48 hours before a meeting can take place. For some beneficiaries it may be inconvenient to travel just to sign a form and then travel out again to meet the agent.  This can result in a few missed appointments.   All the effects of the rule remain to be seen.  It is certainly not one many agents are overly excited about.

Learn more about the CMS final rule 2024

Whatever the result, the 48-rule being put back in place means agents have to change how they do business.

Need a Scope generic of appointment, click here

to view more images by this artist. click here