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Clover Health OTC catalog 2024

The Clover Health OTC catalog 2024 provides members with numerous choices to help them get the most out of their OTC benefit.  Members of Clover Health MAPD plans have the added benefit of the LiveHealthy Rewards Program.

To get started with your Clover benefits, just go to the clover member site and register for your My Clover account.  From there, you can check your reward status as well as your OTC benefit balance, shop online or find a local, participating store and much more.  Clover plan members can access both their OTC and LiveHealthy rewards benefits with their LiveHealthy Flex Plus card.

Agents, watch a quick YouTube video on how to choose carriers to contract with.

OTC catalog benefits:

Clover provides all MAPD plan members with a quarterly OTC benefit allowance of between $30 and $75 (amount depends on the plan benefit).  At the beginning of each quarter, OTC and LiveHealthy rewards dollars are loaded onto the Live Healthy Flex Plus card automatically.

OTC Benefit amounts do not roll over to the next quarter. Plan members must use the benefits before the end of each quarter.  Cards are only valid at participating merchants for approved items.

To download o copy of the OTC catalog and how to use this benefit, Click here

Download the Clover OTC benefit and live healthy rewards guide

Existing Clover members:

Existing plan members will not receive a new LiveHealthy Visa Flex Plus card.  Their current card will have OTC as well as LiveHealthy rewards loaded onto it.  Any unused Livehealthy dollars roll over from 2023 to 2024.

If you need a replacement card, you can either order one online at cloverhealth.com/livehealthy or call 1-800-607-2348 (TTY711) 8:00 AM – 8:00PM, local time 7 days a week.

LiveHealthy Rewards:

Members who complete the following activities earn rewards.
1.  Earn $100 per year to complete the “Getting to Know You Survey”.  This survey is a modified health risk assessment.  Each member can complete the survey online, over the phone with member services or by filling out the paper form included in your welcome kit. Rewards are loaded onto the card 3-5 business days after survey is complete.  Rewards are not available to spend until after the plan start date.  Member may complete a survey each year to earn rewards.

Brokers please note; if you help a new member fill out the online survey within 72 hours of submitting the application earn $50.

To learn more about HRAs, click here.

2.  Members earn up to $50 annually for preventative care.  This includes $10 for receiving a flu vaccine, $20 for an A1C test and $20 for a retinal eye exam.  Clover validates completion through claim or by self-attestation for flu vaccine.  Clover loads reward dollars 3-5 business days after they receive the claim.

3.  Complete a LiveHealthy visit to earn $150 annually.  Members call the phone number on the back of the LiveHealthy Flex Plus Visa card to set up the appointment. The appointment takes place either in the office of a provider, in-home or via telehealth visit.  members are eligible to complete a Livehealthy visit each year.  Benefits are loaded onto the card within 3-5 business days after claim is received.  Please note: providers have up to 90 days to submit the claim.

4.  Get Active rewards are worth $25 per quarter ($100 per year).  Member must participate in one of the following to earn rewards:  SilverSneakers gym or class, either virtual or in-person.  Attend a Clover sponsored event or Clover poll.  Log into the Clover member portal at least 1 time per year.  Clover confirms member participation and rewards dollars are loaded 3-5 business days.

Click here to contract with Crowe and offer Clover health plans.

The difference between the OTC benefit and LiveHealthy Rewards:

OTC benefits provide plan members a monthly allowance to purchase common health care items while members earn Live Healthy rewards by completing activities that promote good health.

The annual OTC benefit amount is between $120 and $300 per year while members can earn up to $400 in Healthy rewards benefits annually.

While there are restrictions on what members can purchase with the OTC card, members can use Rewards dollars to purchase of most items with the exception of alcohol, tobacco and firearms.  Members who go over the OTC limit, can use rewards dollars to complete the purchase if they are available.  Any purchase in excess of the Rewards dollar is the responsibility of the member.

Important: Members may not use LiveHealthy Rewards dollars to purchase alcohol, tobacco products, or firearms. Rewards are not redeemable for cash.  Some other limitations apply, members should check with Clover member services for more information.

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Medicare Part D enrollment period

Medicare plans all have specific periods of time that beneficiaries can use to enroll in each type of plan.  Medicare Part D (prescription drug coverage) is no different.  There is more than one Medicare Part D enrollment period available to beneficiaries.

Please note: Beneficiaries can get Medicare Part D coverage from either a stand-alone PDP plan or from an MAPD plan.

Why enrolling in Part D is important

If your client asks why they should enroll in Part D coverage, you need to tell them about the late enrollment penalty (LEP). Once a beneficiary incurs a penalty, they have to pay it for as long as they have Medicare Part D coverage.  It is added to The Medicare Part D plan premium.  This penalty amount is determined by the number of months the beneficiary has gone without creditable drug coverage.  The penalty applies after a beneficiary goes 63 days or more without creditable coverage. Creditable coverage means a drug plan that provides coverage at least equal to what Medicare part D provides.

Here are a few instances that can result in an LEP

1. When a client Neglects to enroll in Part D as soon as they are eligible.  Enrollment in Medicare Part A & Part B is a great indicator of when to enroll in part D coverage.  It is important to enroll even if the client is not currently taking any prescription drugs.
2. If the beneficiary loses other health coverage such as employer coverage, it is important beneficiaries do not go without creditable coverage for 63 days in a row.
3. Once clients are eligible for Medicare, be sure they maintain records of creditable coverage in the event Medicare asks for proof of previous coverage.

Do you want to join our team, click here for online contracting with Crowe

Medicare drug price negotiations

Because of the high cost of some prescription drugs for Medicare beneficiaries, the CMS has announced the first 10 drugs that will be subject for Medicare drug price negotiations.  The negotiations are part of the Inflation Reduction Act.  Up until recently, Medicare has been able to negotiate prices for medical care beneficiaries receive but this did not include the costs of medications.  This is about to change when the negotiated prices go into effect as of 2026.

Watch a quick video on the Medicare Part D changes 

Medicare will negotiate with drugmakers over the cost for the some of the most expensive medications and does not apply to drugs that have a generic alternative.  The first 10 medications chosen for negotiations are:

1. Eliquis (a blood thinner)
2. Enbrel (for rheumatoid arthritis)
3. Entresto (for heart failure)
4. Farxiga (for diabetes, heart failure & chronic kidney disease)
5. Fiasp & Novalog (for diabetes)
6. Imbruvica (for blood cancers)
7. Januvia (for diabetes)
8. Jardiance (for diabetes)
9. Stelara (for psoriasis & Chron’s disease)
10. Xarelto (a blood thinner)

According to the CMS, the 10 drugs above accounted for 20% of the Medicare Part D spending ($50.5 billion) during the period from June 2022 through the end of May 2023.  Part D of Medicare covers prescriptions taken by beneficiaries at home.  It does not cover medications administered by medical providers in medical facilities for treatment of things like cancer or other health conditions.  In these situations, Medicare Part B covers the necessary drugs.

Click here to read the drug price negotiation fact sheet 

Medicare beneficiaries spend billions of dollars for prescription drugs

Because of the high cost of some essential medications, beneficiaries sometimes have to either limit basic needs or go without the drugs that help maintain their quality of life.  All the while, drug manufacturers rake in record setting profits.

These 10 drugs are just the beginning

This list of 10 drugs is just the starting point.  In 2027 Medicare hopes to add 15 more drugs and even more in the years that follow.  This list will grow each year as long as the drug manufacturers are unsuccessful in their attempts to stop the drug cost negotiations.

Find out about the Medicare prescription payment program.

What will drug manufacturers do

If the drug companies do not agree to the negotiations, they face possible tax penalties.  Drug manufacturers can avoid the tax penalty if they remove their drug from the Medicare market.  However, if they do that, they will take lifesaving drugs from Medicare beneficiaries as well as lose a large part of their market share.

Some large drug companies are seeking legal counsel to stop the drug price negotiations.  They argue that the loss in income will affect their ability to fund necessary research and development and that in turn will reduce their ability to produce new medical treatments.

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Think Agent Aetna login

Because Aetna is one of the leading Medicare carriers in several states, there are many agents who will need a Think Agent Aetna login.  Think Agent is the electronic enrollment tool Aetna provides to help their agents enroll Medicare beneficiaries in their plans.  Think Agent gives both agents and clients a quick and easy way to complete their enrollments.  This tool is available several different ways including, desktop, laptop or a mobile app that agents can add to all their mobile devices including their phones.

How to access Think Agent

1.  Once you are ready to sell with Aetna, you will be able to download the Think Agent app from either the Apple App store or the Google Play store. Please note: The app is compatible with Android 5 or greater, version 11; or IOS 11.0 or greater, version 14.5; or on your desktop.  To access think agent online click here.
2.   After you download the app, click sign up and submit your request for a new user account.  To create your account, you need to provide your name, NPN and email address.

Click here for online contracting to offer Aetna or other Medicare products

Humana Vantage broker portal

The Humana Vantage broker portal is an invaluable tool for Humana appointed agents.  If you are appointed with Humana and have your Humana writing number, you can access the Vantage broker portal.  Just go to humana.com, go to the sign in and enter your username and password.  For new agents, just click to activate your online profile and use the prompts to setup your Humana portal access.

Click here to add Humana to an existing Crowe contract or to start a new contract with Crowe.

Licensing, Certification and Contracts

In this section of the portal agents find their status for licensing, certification and contracts. This helps agents stay up-to-date and ready to sell.

Education

The education section takes you to Humana MarketPoint University.  Once you are in MarketPoint, you have access to complete certifications and any training you need.  You can also access training webinars and job aids.

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What is a Medicare HRA

If you are in Medicare sales, you may have heard the term HRA.  In this post we will explain what is a Medicare HRA and why insurance carriers use this tool.

What is a Medicare HRA

HRA stands for Health Risk Assessment.  Medicare Advantage plans must do an HRA for every beneficiary within 90 days of their initial enrollment.  MA/MAPD plans require qualified health care professionals to conduct HRAs for existing members once a year.  These assessments are an important tool for both health plans and providers.  Insurance carriers use HRAs to identify the health status of members.  Once the HRA is completed,  insurance companies make risk adjustments and providers can put a managed care plan in place when necessary.  Clients may decide to have the HRA done either in a provider’s office or at home.

The HRA is required by CMS for all members of both Medicare Advantage and traditional Medicare fee-for-service plans.  If the member is enrolled in a traditional Medicare Fee-for-service plan, The member’s initial (welcome to Medicare) or preventative visit is used for the HRA.  When the member is enrolled in a MA/MAPD plan, the member will be asked to have the HRA.  Medicare advantage plans must make a “best effort” to have the member complete the HRA each year.

Click here to watch a quick YouTube video on Medicare Advantage vs. Medicare Supplement plans

HRAs (Health Risk Assessments) help collect important information

The information obtained through a HRA provides a view of the enrollee’s general health, health risk factors, as well as a glimpse into their ability to complete activities of daily living.  All these factors provide a view of overall health as well as find gaps in care and provide a basic diagnosis.

Any information obtained can help providers and health plans to create population health initiatives as well as to put an individual health plan in place.  The plan may include care management, coordination of care, identification of  high-risk individuals and the development of comprehensive care plans with referrals to suitable care team members.

Agents who want to offer Medicare Advantage plans, click here for online contracting

How to conduct a Health Risk Assessment

CMS has not put any specific format in place to conduct the assessments.  In many cases, a health care professional asks the beneficiary a series of questions. The questions cover a large range of topics that include family medical history, the beneficiaries current health, their lifestyle and their willingness to adapt behaviors that can improve their health.  The answers provided all correspond with a numerical value that determines the weighted risk value and health of the beneficiary.

Because Medicare Advantage companies receive payments from Medicare for each enrollee, Medicare uses this information to help calculate the payments. Health plans receive a prospective capitated payment that is based on the projected cost of care for each beneficiary.  Medicare adjusts the payment according to the amount of risk the company assumes per enrollee.  This helps ensure the company is able to cover the costs for the care for it’s enrollees.  That is why so many Medicare Advantage plan carriers offer their agents an incentive to ensure that new plan enrollees have the HRA completed.

For CMS to accept the HRA for the risk-adjusted payment, it must be either documented in the patient’s medical record or performed as a face-to-face visit with a licensed medical provider and the beneficiary.

Learn about CMS’ Part D drug cap

HRAs are an important tool

HRAs along with a good care management team are a great way to identify and support the specific health care needs of the individual to ensure improved health and better quality of life.

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United Healthcare OTC catalog 2024

Members of participating UHC Medicare advantage plans have access to the United Healthcare OTC catalog 2024.  There are 3 different types of UHC Medicare Advantage plans that have their own OTC benefit package.  Members of all 3 plan types can access their OTC benefit through their UCard.  The UCard is more than just a member ID card, it is a way to access all the extra benefits UHC members receive.

Members of these plans have access to an over-the-counter credit.  United Healthcare adds the credit to members UCards either monthly or quarterly.  This depends on the plan each member enrolls in.  To find out if your plan offers this benefit and the details, check the evidence of coverage for your plan.

Member can shop in over 55 thousand participating stores.  Participating stores include CVS, Kroger, Walgreens, Walmart as well as Meijer, Sam’s Club and Save A Lot.
Shopping in stores provides a greater product selection for members that include both generic and Brand-name items.  Members also have the option to order items online, by phone or through the mail.

Please note:  This year the OTC catalog is too large to add as a download to the blog, that is good for plan members!  Members can call the member services number on the back of their card to request a copy be mailed to them.

The best way to see the OTC items is either online or through the mobile app.

View the catalog with the UHC Mobile app  – click here for instructions

Click here to access the OTC store finder

Unused benefits for Plans that provide a monthly combined credit for OTC/Healthy Foods/Utilities expires at the end of each month.

Ways to order OTC items

Members of participating UHC MAPD (non-SNP plans) have 4 ways to order OTC items with their UCard or prepaid card. In 2024, 68% of all non-DSNP members have access to the OTC benefit.

UHC 2024 OTC (Non-SNP) brochure

1.  Order in store at one of over 55k participating locations.

2.  Purchase OTC items online whenever it’s convenient for you 24/7.

3.  Use the phone to order OTC items.

4.  Use the mail order form in the OTC catalog to order items.

Please note, items ordered either online, over the phone or by mail will usually be delivered within 2-3 days of receipt.  Orders over $35 are eligible for free shipping.

Click here to download the 2024 UCard Quick Reference Guide

Information for C-SNP members

UHC 2024 OTC and Healthy Foods (CSNPs) brochure

C-SNP members have access to a monthly credit for OTC benefits as well as healthy foods benefits on their UCard.

Members have a few ways to shop for OTC items.

1. In store
2. Online through the member portal
3. Use the catalog and purchase items by mail.

Delivery is free on orders of $35 or more.

C-SNP members can choose from thousands of healthy food items including meat, fruit. vegetables, dairy bread cereal and much more.  There are a few ways to shop for healthy foods using the monthly allowance on the UCard.  Delivery is free with Walmart or Roots.

In 2024, there are 42 C-SNP plans that offer the OTC healthy food card.  In past years, this benefit was only available on the DSNP plans.

1. Shop for healthy foods in store
2. Choose from the items online through the member account,
3. Use the UnitedHealthcare mobile app to check your account balance or locate local retailers.  Use the scan to find available products and check outin stores without your UCard.

Orders can be placed by calling 1-888-628-2770 (TTY: 711). You can talk to an agent Monday to
Friday, from 9 AM to 8 PM local time. Please have your order ready before you call. 

OTC benefit information for D-SNP members

UHC 2024 OTC, Healthy Foods and Utilities Credit (DSNPs) members

OTC benefits for D-SNP plan member in 2024 include over-the-counter items as well as healthy foods and utilities benefit.  This benefit is loaded onto the UCard each month and member can choose to use it in any of the ways mentioned above.  Credits are loaded onto the UCard each month

D-SNP members can decide to use their benefit to shop one of the following ways.

1. In one of the thousands of participating stores.
2. They can also choose to shop online through the member portal.
3. Members may also use the catalog to order items through the mail using the form in the catalog.

Members can purchase Healthy Foods in one of the following ways:

1. Members can shop in-store
2. Online through the member portal
3. They may also use the catalog to choose food items and have them shipped to their home, the same as with OTC items.  Home delivery is free with Walmart or enrollees may choose Roots for fresh produce and premade meal delivery.

The utility benefit can help members pay electric bills, water and sewer usage, sanitation, heating or internet service. FOr utilities, the service address must be the same as the member’s home address that is on file with United healthcare.

Member can request a replacement catalog online or by contacting member services. 

The number for each plan’s member services team is found on the back of the member ID card.

Medicare agents- get contracted to sell United Healthcare plans

Additional information

In most cases, United Healthcare will answer member inquiries.  There are some benefits supported by different vendors depending how the member orders the product.  Items that are ordered online, over the phone or with the catalog will be filled by Solutran.   Some orders are supported by Walmart.

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Medicare prescription payment plan

The Medicare prescription payment plan is also referred to as “smoothing“. This is a way to help Medicare beneficiaries pay for the high cost of prescription medications.  The Medicare prescription payment plan is one small part of the inflation reduction act of 2022.

Watch a quick YouTube video on potential changes to commissions in 2025

When will the program start

In 2025, Medicare Part D (PDP) plan enrollees have a chance to opt for a prescription payment program.  The plan will help beneficiaries pay out-of-pocket costs for prescriptions.  Everyone in a PDP plan has a chance to enroll in the payment program, it is not based on income.  Enrollees have the option to enroll before the plan year starts or during any month of the year.   Please note, the payment plan does not include plan premium payments.

Here are some of the details

Participation in the Medicare prescription payment plan is optional.  PDP plan enrollees must choose to be part of the program.  Once an enrollee joins the program, and has out-of-pocket prescription costs, they receive a monthly bill to cover those costs.  Any out-of-pocket costs for prescriptions are included even during the deductible phase of PDP coverage.  There is no minimum out-of-pocket amount required before anyone can join.  Participants receive a monthly bill as long as they remain part of the program.

How is the monthly payment amount decided

There will be an annual cap of $2,000 on out-of-pocket costs in 2025.  The amount each beneficiary pays for their monthly plan depends on a few different factors.  It is not as easy as dividing $2,000 over the course of 12 months.

Learn more about the Part D drug cap

1. The Medicare prescription payment plan will deduct the out-of-pocket amount beneficiaries have already paid before enrollment in the program.
2. Any remaining costs are then divided by the number of months left in the year.

CMS will create a payment calculator so Part D beneficiaries can decide if enrolling in the payment plan is a good idea or not.

CMS is still working out the details of this program

We do not know exactly how the prescription payment program will work yet because the details have not been finalized by CMS yet.  We will post additional details as they are available to the public.

Please note:  This program is set to start in 2025, the same year the annual drug cap will be set at $2,000.  In other words, no Part D enrollee will pay more than $2,000 out-of-pocket for their prescriptions.

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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.

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.

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