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The Medicare Extra Help program, also known as LIS (Low-Income Subsidy), is a valuable resource for Medicare enrollees with limited income and resources. Individuals who qualify have a reduction in the cost of prescription drugs. Extra Help provides an important benefit. It helps lower premiums, deductibles, and copays. The Extra Help income limits 2025 have been increased to keep up with the cost of living. This ensures a greater number of individuals will qualify for the program.

The Extra Help program is available to individuals who:

1. Reside in one of the 50 states or Washington, D.C.
2. Are enrolled in Medicare Parts A and B
3. Are a member of a qualified Medicare Part D plan; either a stand alone or a MAPD plan.
4. Have assets and income at or below the annual limit set by the Department of Health and Human Services.
5. Those enrolled in Medicaid automatically qualify for the program

The Medicare Extra Help Program

The Extra Help/LIS program gives Medicare beneficiaries financial assistance to ensure they can afford their prescription drug costs. The program provides different levels of support level of depending on the income level of the beneficiary.

The levels of Extra Help include Full extra Help and Partial Extra Help. Full Extra Help provides coverage for the most prescription drug costs. This includes plan premiums as well as deductibles and copays. Partial Extra Help gives enrollees who’s income exceeds the threshold by a small margin. These beneficiaries receive reduced financial assistance with premiums and copays.

How to Apply

Individuals who may qualify for the Extra Help program in 2025, can use the following steps to apply: Please note; anyone enrolled in Medicaid is automatically enrolled in the Extra Help program.

Apply online at the Social Security Administration  Beneficiaries can also call Social Security to enroll at 800-772-1213 or TTY: 800-325-0778. Representatives are available to help from 8 am until 7pm CT weekdays M-F. To enroll in person call Social Security and make an appointment at your local Social Security office. Click here to locate your local Social Security office .

Extra Help Income limits 2025

To qualify for LIS/ Extra Help beneficiaries must have income either at or below the threshold set by the Social Security Administration for 2025.

Starting in 2025, the income limit for individuals is $22,590, for married couples, it is $30,660. Asset limits; such as bank accounts, stocks, and bonds must be at or below the resource limits of $16,100 for an individual or $32,130 for married couples.

Here is a list of resources that are considered when applying for Extra Help:

1. Real estate that is not your primary residence.
2. Bank accounts (checking, savings and CDs).
3. Stocks, U.S. Savings Bonds, Mutual Funds.
4. IRAs
5. Cash

What doesn’t count as a resource

1. The beneficiary’s primary residence.
2. Their personal vehicle
3. Any resource that doesn’t easily convert into cash (jewelry or furniture).
4. Rental property used for personal support or land used to grow food for personal consumption.
5. Life insurance or burial expense policies; this includes interest earned on money set aside for burial expenses.

Medicare agents may be able to provide assistance with MSP/LIS applications. In addition, some applicants may qualify for DSNP plans, be sure to check their level of Extra Help and provide assistance to those who qualify for a DSNP plan in your area.

Click here to learn about the SEP Changes for Dual, Partial Dual and LIS members in 2025

As AEP draws to a close some agents wonder what’s next. OEP is next, and we will go over a few reasons why Medicare OEP 2025 is important. After AEP, many agents want to take a break, we will discuss why this is not a great idea.

Click here to watch a YouTube video on Medicare OEP best practices

What enrollees can do during MA/MAPD OEP

First, we will discuss what you can do during the Medicare Advantage OEP. The OEP takes place from January 1 and goes through March 31 each year.

Those enrolled in a Medicare Advantage plan of any type can change from one MA/MAPD plan to another.

MA/MAPD plan enrollees can opt to disenroll from their plan and enroll in Original Medicare. If they opt to enroll in Original Medicare, they can add a PDP plan and possibly a Medicare Supplement plan. Please keep in mind, the Medicare Advantage OEP does not create a guaranteed Issue period for MS plans in underwritten states.

What enrollees cannot do during MA/MAPD OEP

Another important thing about the MA/MAPD OEP is knowing what you cannot do.

Beneficiaries enrolled in Original Medicare cannot enroll in an MA/MAPD plan. To take advantage of the MA/MAPD OEP, the beneficiary must be enrolled in some type of Medicare Advantage plan.

Plan enrollees cannot change plans more than once during this enrollment period.

Why the Medicare OEP 2025 is important

The 2025 OEP is especially important because of the amount of changes that are taking place. Many clients may decide to stay in their current plan and did not realize their plan had changed. Some plans have lost or lowered benefit amounts for specific services.

Because in 2025, Dual eligible plan enrollees do not have a quarterly SEP unless they change into an integrated plan, they may need to use the OEP as a way to make a plan change.

Watch a YouTube video on Dual Partial Dual and LIS member changes

Please note; Some plans have been discontinued for 2025. When this is the case, anyone enrolled in a discontinued plan should use an SEP for a plan term. The SEP for plans terminating runs from 12/8 through 2/28.

As always this is another way for agents to be sure their clients are happy with the plan they chose during AEP. If they are not, you have another chance to ensure they find a plan that provides the coverage they are looking for.

Things agents can and can’t do during MA/MAPD OEP

There are some things agents can do during the OEP (Jan 1 – March 31). They can market to people turning 65; this is what they should be doing year round. It is also market to anyone with an SEP. Agents can also check on clients to ensure they are happy with their plan choice and offer to answer any questions they have.

Click here and learn about SEPs

Agents cannot actively market the OEP. This includes sending beneficiaries communications about making changes using the MA/MAPD OEP specifically.

Most years, beneficiaries receive an increase in their Social Security benefit payments.  This is referred to as a COLA.  For 2025, the Social Security increase 2025 will be only 2.5%.  This is lower than 2024 of 3.2 and much lower than the 2023 increase of 8.7%.

The U.S. Bureau of Labor Statistics calculates the COLA with data they get from the CPI (Consumer Price Index). The CPI tracks the costs of goods & services. 

An annual increase in Social Security benefits provides seniors some relief against the high cost of inflation and provides them a little more purchasing power annually.  In turn, this helps the overall economy.

How this helps beneficiaries:

The 2.5% COLA increase provides beneficiaries an increase in their Social Security checks.

Usually the is COLA increase, leads to an increase in Medicare Part B premiums. Because, in many cases, Medicare premiums are deducted from Social Security checks, therefore beneficiaries may not notice the COLA increase at all.

Please note, federal law has a hold harmless clause that states, “no increase in Part B premiums can reduce a Social Security recipient’s monthly check below what it was in the previous year.”  This is in place to protect Social Security recipients to some extent.

When will recipients see the increase

Social Security recipients will see the increase in January of 2025.  Beneficiaries should be notified in December with their new benefit amount.

Beneficiaries who have a birthday that falls on the 1st through the 10th of the month, receive their benefit on the 2nd Wednesday of each month. Those who have a birthday the 11^th through the 20^th, receive benefits the 3rd Wednesday of each month.  Anyone whose birthday is between the 21^st and 31^st receive their benefits the 4th Wednesday of each month.

Important: Social Security increases can impact eligibility for Extra Help.

Learn about the 2025 prescription payment plan

Find your benefit amount

The fastest and most convenient way to keep track of social security benefits is by creating a Social Security account.  Beneficiaries can use the account to check Social Security statements, report wages, change their address and more.

Create a my Social Security account

Starting in December, most beneficiaries can view their Social Security COLA notice online. Notices are available in the message center in their online account. Notices will also go out in the mail. Beneficiaries must create an account before November 24, 2024 to view the online COLA notices.

Once the account is created, beneficiaries can log on and manage notification preferences by clicking on  “Message Center Preferences” and choose your message options.  Beneficiaries can opt to receive courtesy messages either in email or by text message. 

Sign up for Medicare online

Some individuals enrolled in Medicare may have an income level that allows them to receive financial assistance with prescriptions. The program that provides this assistance is Medicare Part D Extra Help. Eligible beneficiaries can apply for Extra Help anytime either before or after they enroll in Part D.

Medicare Part D Extra Help

Medicare Part D is the prescription drug coverage plan that helps Medicare beneficiaries pay for prescription medications. However, the costs associated with these plans; premiums, deductibles, co-pays, and coinsurance can add up, especially for those with limited income. Medicare Part D Extra Help (LIS) provides financial assistance to beneficiaries with limited income and resources. This helps reduce the costs of necessary prescription drugs. This program provides a lifeline for those who may not otherwise be able to afford their medications.

Who Qualifies for Extra Help

To qualify for Medicare Part D Extra Help, individuals must meet specific income and asset criteria. Although the SSA adjusts the limits annually, generally, individuals qualify if:

Their annual income is below a set threshold. As of 2025, the income limit for individuals is $22,590, and for a married couple, it is $30,660.

Asset limits; such as bank accounts, stocks, and bonds should be at or below a specific amount. In 2025, the resource limits are $16,100 for an individual and $32,130 for a married couple. Please note; resources like a primary residence and car do not count.

If income and assets are slightly above the limits, beneficiaries may qualify for a partial subsidy, which provides some help with prescription drug costs.

What Does Extra Help Cover

Extra Help provides assistance with several aspects of Medicare Part D costs, including:

1. Lower Premiums: Those who qualify may have a lower or even a $0 premium for their Part D plan depending on the personal finances.
2. Reducing Deductibles and Co-pays: Extra Help lowers out-of-pocket costs for prescription drugs, including deductibles, copays, and coinsurance.
3. Eliminating the Coverage Gap: Also known as the “donut hole,” this is a temporary coverage gap in most Part D plans. Extra Help may completely eliminate this gap, so you won’t have to pay higher costs during this phase. Although in 2025,this is a non-option as the coverage gap will be eliminated.
4. Lowering Drug Costs: The program also reduces the cost of prescription drugs, especially if they’re generic medications.

How to Apply for Extra Help

Medicare beneficiaries can apply for Extra Help in several ways:

1. Online: Visit the Social Security Administration (SSA) website and complete the application form online.
2. By Phone: Call SSA at 1-800-772-1213 (TTY 1-800-325-0778) to apply by phone. They can walk you through the process.
3. In Person: You can apply in person at your local Social Security office; just call +1 800-772-1213 or TTY 1-800-325-0778. Tell the representative you need an appointment to apply for Part D Extra Help.

Those who apply must provide information about income, assets, and any resources that might affect their eligibility.

After the application is submitted

Once the applicant submits their application, SSA reviews the information provided. Usually within 30 days, SSA sends out a notice to let applicants know if they’re approved. The notice will notify them of the specific level of assistance they qualify for. Those who are denied have the right to appeal the decision.

Those who receive Extra Help can continue using the PDP plan they already have, or may be automatically enrolled in a plan that best fits their needs. It’s important to review plan options each year during the Medicare AEP (October 15 – December 7) to make sure the current plan is still the best choice.

Watch a YouTube video and learn about changes for Dual, Partial Dual and LIS SEP changes

Can you remove or change Extra Help

Yes, Extra Help is subject to change if the beneficiary’s financial situation changes. If there is an increase in income or assets, beneficiaries may no longer qualify for the full subsidy. However, they may still qualify for a partial subsidy if income and assets are within specified limits.

Those who are unsure if they are eligible should reach out to the Social Security Administration or their Medicare agent for more information.

For millions of beneficiaries, Medicaid provides a much needed lifeline. This ensures they receive access to essential healthcare services. However, one common question Medicaid beneficiaries have is does Medicaid coverage renew automatically. Although the answer depends on the state and specific circumstances of each enrollee, understanding the Medicaid renewal process helps avoid a lapse in coverage.

Medicaid renewal, also known as redetermination, is the process each state uses to determine if a beneficiary is still eligible for Medicaid benefits. Periodically, each state must verify the beneficiary’s income, household size, and other factors to ensure they still qualify for the program.

Click here to apply for Medicaid in each state

Does Medicaid coverage renew automatically

The short answer is: In some cases, Medicaid renewals are automatic, while others require the beneficiary to provide information to their resident state for renewal.

Automatic (passive) renewal

In many states, if the Medicaid office can verify eligibility through their databases (e.g., tax records, Social Security information, or unemployment benefits), coverage may renew automatically. If this happens, beneficiaries receive a notice in the mail informing them that coverage has been renewed without further action required.

Active Renewals

If eligibility cannot be verified automatically, beneficiaries must complete a renewal form and provide the requested documentation. States may typically send a renewal notice by mail or email depending on the beneficiary’s preferences. The notice includes instructions as well as a deadline to submit the required information.

What Triggers the Need for Renewal

Medicaid renewal usually occurs annually, though the exact timing varies according to when each beneficiary first receives Medicaid. Some reasons for renewal are a change in household size or a change in income. State policies differ and may change and require information for a renewal.

How to prepare for Medicaid renewal

Whether renewal is automatic(passive) or requires action, the following tips can help ensure a smooth process:

Beneficiaries must notify their state Medicaid office immediately if their address, phone number, or email changes. This ensures they receive renewal notices and other important information. They should also watch their mail for important notices and respond quickly. It is also important to keep recent pay stubs, or tax returns as proof of income.

Be aware of the deadline for renewal to respond in a timely manor and avoid a lapse in coverage.

Click here to learn the difference between Medicare and Medicaid

What If the renewal deadline passes

Failing to complete the renewal on time can result in a termination of benefits. However, most states offer a grace period that allows beneficiaries to submit renewal documents and have coverage reinstated retroactively.

Whether renewal is automatic or requires action, keeping your information updated and responding promptly to notices are imperative to maintain benefits.

Additional information

Most states have expanded Medicaid programs that cover anyone with a household income below a specific level.

In every state, Medicaid qualification is based on income, household size, disability and other factors. The exact qualifications differ by state. States the have expanded Medicaid coverage offer Medicaid based on income alone. When household income is less than 133% of the federal poverty level. A few states use a different income limit.

Each state has it’s own Medicaid renewal process. Beneficiaries can contact their local department of Social Services/Medicaid office or visit the state’s Medicaid website for detailed guidance.

Why use a Medicare agent

If anyone asks why people use Medicare insurance agents, we have a few good reasons below.

To start; Medicare agents complete hours of training on both compliance regulations.  They also complete hours of study and testing on the Medicare products available in their area.  They must be well versed on the plans and provide detailed information to clients. A good agent can provide comparisons of several plans and help find the Medicare plan to best fit their needs.

learn the difference between Medicare Advantage and Medicare Supplements,

Compare plan choices

Because health insurance coverage is such an important decision, it is important for clients to understand all their choices. Choosing the wrong plan can be a very costly mistake.  For this as well as many other reasons, the help of a licensed Medicare agent is essential. A Medicare agent can go over the client’s list of wants/needs for coverage and find plan options that are right for them. Agents help clients weigh the benefit of each plan. Medicare plan benefits, rules, and exceptions may be overwhelming to sort out without a trained professional.

To find out about our quoting tools, Connecture and Sunfire, click here

Consider the client’s current coverage

It is important to consider the client’s current Medicare coverage and find out what about the plan works or does not work for them.  With this information in mind, it is easier to find help them decide whether they should stay in their current plan or if there are better options available to them.

Agents do not charge for their service

As a Medicare agent, you cannot take money from the client for the advice you provide.  This means clients receive expert advice at no cost.  This service is provided for free.  That is one deal you cannot beat!

Medicare agents receive payment through a couple different ways depending on the type of agent they are.  Agents who are employed by and insurance company receive payment based on their agreement with their employer.  Many other agents who are not captive with a carrier, receive payments through the commissions they earn.  They may receive this payment directly from the carrier or if they are LOA, they receive payment from their up-line.  Either way, the amount they make is based on their total number of sales made.

Please note: commission amounts vary based on the plan type and carrier as well as the level each individual agent is contracted at.

Find out about commission levels for 2025

How clients choose a Medicare agent

Here are some things clients may consider when they choose a Medicare agent.

1.  The first way clients choose an agent is usually word of mouth.  If you have done a great job helping their friends, relatives or co-workers, believe me they will hear about it.  People love to tell their friends about an agent who really did a good job for them.  That is why all your clients need to know that you are there to answer any questions or concerns they have.
2. Clients feel better knowing they are working with an experienced agent someone who understands the plan benefits and how they work.  Be sure you are up to date on all the plans in the areas you sell in as well as what the rules for enrollment are.
3. Offer many different carries and plan types for each area you sell in.  Clients want to work with an agent who has access to all the best plans in their area.  Each client is an individual and one plan type may not be the best choice for every client. Do not offer only Medicare Advantage plans as some clients are better off with a Supplement and PDP plan.

Click here for a scope of appointment

A knowledgeable and caring Medicare agent is a very valuable resource for the community. If you make sure you are well informed and truly enjoy helping those who need advice on Medicare coverage, you can become a successful agent with the right amount of time, effort & training.

Because an IRMAA is based on income reported on tax returns from 2 years prior, some Medicare beneficiaries will receive notice their monthly premiums for Medicare Part B and Part D are increasing. In other words, they receive an IRMAA (Income-Related Monthly Adjustment Amount). If this happens, beneficiaries may need to know how to file an IRMAA appeal.

In the event the beneficiary has a significant change in their financial circumstances, they might be eligible to file an appeal to reduce or eliminate the adjustment.

What’s an IRMAA

IRMAA is an additional charge the Social Security Administration adds to Medicare Part B and Part D premiums when an individual has a higher than average income. The SSA uses the beneficiary’s MAGI from 2 years prior to determine the adjustment amount. For example, the 2025 premiums are decided by the MAGI from a 2023 tax return.

Learn about Part B IRMAAs

Find out about Part D IRMAAs – click here

Reasons to file an IRMAA appeal

Those who experience a life-changing event that caused a decrease in income, or feel the IRMAA is incorrect, can request a reconsideration. A few qualifying life-changing events include:

1. Retiring or reduction in work hours
2. Loss of a spouse due to divorce or death
3. Elimination of a pension plan
4. Loss of income producing property due to disaster or other circumstance

Click here to watch a YouTube video on Part B IRMAAs

How to File an IRMAA Appeal

1. Read and understand the notice

The initial determination letter from the SSA explains the IRMAA and includes instructions for appeal. It is important to understand if the IRMAA is based on outdated or incorrect information.

2. Gather supporting documents

Get any documents together that prove a difference in your current financial situation compared with two years prior. Examples of this may include:

• Employer letter that confirms retirement or reduced work hours
• Divorce, marriage or death certificates
• Tax returns that show lower income
• Insurance claims or documentation of property loss

3. Complete the SSA-44 form

When a beneficiary receives an IRMAA, they should receive instructions to file an appeal including the SSA-44 form. For those who need a SSA-44 form, click here to download and fill it out. The form will request details about life-changing events, current income, and expected income for the year.

4. How to submit the appeal

Once the form is complete, add supporting documentation and either mail it to the address included in the determination letter or on the SSA-44 form or drop it off to a local SSA office. Be sure to follow up on the appeal and provide any additional information SSA requests. Those who file an appeal receive a written decision.

If the appeal is denied

Those who have their appeal denied can request a hearing before an administrative law judge. A request for a hearing must be filed within 60 days of denial receipt. For more complex cases, it may be a good idea to seek professional assistance from an attorney, financial advisor or Medicare expert.

Some ways to ensure a successful IRMAA appeal include; filing the appeal as soon as possible to avoid overpaying premiums. It is also important to make sure all documents are accurate and through and know when expert advice is necessary.

If you are a Medicare agent who wants to join the Crowe team; click here for online contract

As we approach the new year, many people are wondering about the increase in Social Security COLA 2025. Millions of Americans rely on Social Security benefits as their only source of income. That is why the increase is so important. It is in place to help offset the increase in the cost of living.

Social Security Payment Increase

Recipients of Social Security expect an annual COLA to their benefit. The adjustment helps maintain purchasing their power in the face of inflation. The Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) is a measure of inflation and helps calculate the annual COLA.

In 2025, beneficiaries will see an increase in their monthly payments.  The COLA is expected to be 2.5% for 2025. This adds up to around $50 more to the average monthly benefit which is about $1,900, according to SSA. Although the 2025 increase is not as large as the 2023 COLA of 8.7%, 2025 will provide a modest but helpful increase, reflective of ongoing inflation increases.

Why Social Security Payments Increase

The increase is driven by the need to adjust benefits to keep up with inflation. As the cost of goods and services rise, Social Security recipients often find their benefits do not stretch as far as they once did. Keeping Social Security payments in line with inflation, ensures the government helps recipients maintain their standard of living in the face of rising prices.

Impact on Social Security Beneficiaries

1. Retirees: The majority of Social Security beneficiaries are retirees who rely on the payments to cover their living expenses. A COLA increase, no matter how small, helps offset rising costs for food, healthcare, and housing.
2. Disability Beneficiaries: Those receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) will also receive the increase. These individuals, often living on limited income, are particularly vulnerable to inflation, so any increase helps.
3. Survivors and Spouses: Survivors, widows, and widowers who receive Social Security benefits based on the work record of a deceased spouse are another group who the COLA increase provides some relief to as prices increase.

Does the COLA Affect Taxes

It’s important to remember; Social Security benefits are subject to federal income tax, unless your income is below specific thresholds. Unfortunately, the increase in benefits could push some recipients into a higher tax bracket, especially those with substantial income from other sources like pensions, retirement savings, or wages.

In most cases, the increase will be absorbed into daily expenses rather than having a major impact on their taxes. Those concerned about their tax situation may want to consult a tax professional.

Inflation and the Future of Social Security

Although the COLA increase is necessary to ensure that benefits keep up with inflation, there are still concerns about inflation and the future of Social Security. The program has been under financial strain for many years, and there are ongoing discussions on how to secure it’s benefits for the long-term.

Because of the uncertainty about the long-term stability of the Social Security Trust Fund. Proposals to reform or adjust the system continue to circulate. Proposals include things like increasing the payroll tax and raising the retirement age.

For beneficiaries to prepare for the changes ahead, they must stay informed about increases and how they impact their finances. Although in most cases, Social Security does not meet all financial needs, it is critical for the financial security for millions of Americans and any increase can make a difference in the lives of those who rely on it.

The 3 primary out-of-pocket costs to consider when you compare Medicare plans are; copays. coinsurance & deductibles. Medicare copays, coinsurance and deductibles all contribute to annual coverage costs for plan enrollees each year. These terms all describe the money beneficiaries pay towards health care services and prescription drugs when they have health insurance. 

Copays

A copay is a fixed amount of money beneficiaries pay for a specific service. They generally apply to: primary care provider visits, specialist visits, prescription drug refills (depending on the tier of the drug), and hospital services. Copays let the beneficiary know what they pay for each provider’s visit up front. Copays apply to most prescription drug plans, Medicare Advantage plans and some Medicare Supplement plans. Please keep in mind, sometimes there are other costs associated with a visit to a provider’s office.

Coinsurance

When a beneficiary and their health plan share the cost of approved medical services, that is coinsurance. Coinsurance payment amounts are based on a percentage of the cost. Beneficiaries enrolled in Original Medicare, will have to pay 20% of the cost for most services after they meet the annual deductible. After the enrollee meets the deductible, Original Medicare covers 80% of all approved costs.

Usually members of Medicare Advantage plans pay co-pays for medical visits instead of coinsurance. Although in many cases, MA/MAPD plan enrollees pay 20% coinsurance for Part B drugs (in-network).

Up until 2025, stand alone PDP plan enrollees could end up paying 25% coinsurance for drugs if they fell into the donut hole (coverage gap). The coverage gap was removed for 2025, therefore stand alone PDP enrollees do not pay coinsurance.

Click here to learn about the Part D prescription payment program

Deductibles

Deductibles are the amount plan enrollees pay out of pocket for most health care services before their plan starts to cover medical costs. The deductible does not apply to preventative services. Medicare plans cover preventative services at not cost to enrollees.

Once the deductible is met, enrollees are still required to pay copays and/or coinsurance costs.

There are 2 different deductibles for Original Medicare Part A & Part B, however many Medicare supplement plans cover the Part A deductible. There only 2 plans that cover the Part B deductible (Plan F & Plan C) neither plan is available to anyone who turns 65 after 1/1/2020.

Most MA/MAPD plans have separate deductibles; one for medical costs and one prescriptions. That means enrollees must meet their medical deductible before the plan pays for specific covered services. It also means enrollees must pay the deductible for prescriptions before the plan covers the cost of the medication. MA/MAPD enrollees still pay copays and coinsurance after they meet the deductible. Please note; each plan is different and deductible amounts are specified in a plan’s summary if benefits.

Watch a quick YouTube video on the $2,000 drug cap

Copays, coinsurance, and deductibles

Copays, coinsurance & deductibles are all factors to consider when discussing Medicare options. All these things contribute to the total cost of each plan a beneficiary chooses.

If you are an agent who wants to join the team at Crowe, click here for online contracting

Several Aetna Medicare Advantage plans include an OTC benefit. That is why many beneficiaries want to know about the Aetna 2025 OTC catalog and what is in it. OTCHS administers the OTC benefits. They provide plan members with useful OTC products from an approved OTC catalog.

Three ways to order OTC items

1. Order Online: Plan members can register for an online account at CVS.com/otchs/myorder. Members will need their member ID and an email address. Once they have an account set up, they can log in and view their OTC benefit balance and the OTC items available to order. Once they choose items to order and follow the prompts they can place the order. OTCHS will deliver the items by mail at no cost.
2. To place an order by phone: members can call 1-833-331-1573 (TTY: 711). Agents are available to take OTC orders 9 am until 8 pm local time, Monday through Friday. Plan members can also use the automated system 24 hours a day, 7 days a week. All items are mailed at no cost to the member.
3. Shop for items in a designated CVS or Navarro store and use the OTC benefit. To search for a nearby location, visit Click here for a store locator. Please note: CVS Pharmacy locations inside eitherTarget stores or Schnucks are not included. It is also important to remember; all locations do not stock every item. Members need to present their Aetna member ID card to the store cashier to verify eligibility for the OTCHS program to finish their purchase.

The OTC Health Solutions app

The OTC app is another way to get more from your benefit. It is easy to download the OTC Health Solutions app. members can find the app at the App store for Apple devices or on Google Play for Android devices. The app lets participating plan enrollees scan OTC products and process an order, view past orders or receive updated account information.

How to use the app in store:

1. Scan the product’s barcode to confirm if the product is an approved item.
2. Show the cashier the digital barcode and check out faster.
3. Once you complete the order, use the app to check the OTC benefit balance.

Learn the difference between HMOs vs PPOs

Additional information

There is no limit to how many orders members can place during a benefit period although some items may have a transaction limit. Specific items such as: blood pressure monitors, digital scales, pulse oximeters and other specific products have a limit of one per year.

Members must submit online orders by 11:59 pm local time to be processed as ordered that day. In most cases, enrollees receive orders within 5 business days. Returns or exchanges are not accepted due to the personal nature of the items. Plan enrollees must report defective items within 30 days of receipt to OTCHS and they will receive a replacement. If an item is out of stock, the member will receive a replacement of equal or greater value.

Members receive an Extra Benefits Card that includes a CVS OTC wallet to purchase items. Members who did not receive their card welcome package in the mail, should call 1-844-428-8147 (TTY: 711) and speak to a Member Services representative from 8am – 8 pm local time, 7 days a week, excluding federal holidays.

Click here for 2025 OTC catalog

OTC benefits help cover the cost of eligible OTC health and wellness products. It is important to remember all Medicare Advantage plans do not include this benefit; different plans provide different benefits.

The Aetna Medicare quarterly benefit is based on calendar quarters: January – March, April – June, July – September, and October – December.

Learn more about Crowe and Associates; visit our website