OTC Benefit Programs

In Medicare Advantage

The Surge in OTC Benefit Coverage

50%+ Market Penetration Due to Recent Regulatory Changes

  • Supplemental Benefit Augmentation
    Flexibility by CMS in determining supplemental medical vs. non-medical benefits available to members, deployed to make plans more attractive

  • Increase in MA Plan Payments
    From 1.84% to the proposed 2020 2.53%, which is encouraging investment in expanded benefits

  • Senior Shopping Preferences
    Supplemental benefits are motivating beneficiaries while they shop for plans–the most attractive benefits being those with "elevated allowances" which equates to "saved money" 

  • OTC Benefits Expansion 
    Far outpacing other newly expanded supplemental benefits for Medicare Advantage members
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The OTC Benefit's Effect On Membership & Savings

Returns on Your Investment

  • A Positive Correlation Between OTC Benefits and Resulting Membership.
    Medicare Advantage products without an OTC benefit in 2018, but that offered one in 2019, had significant growth at 6.5%. Medicare Advantage products without an OTC benefit in 2018 and 2019 experienced a decline in enrollment by 0.02%.
  • Overall Potential for Healthcare Savings
    $1 spent on OTC items can reflect a savings of $7.20 for the US healthcare system resulting in fewer healthcare provider visits, fewer emergency department visits, and lower overall drug costs.
  • Potential for improved Star, HEDIS and Net Promoter Score ratings accompanied by increased member satisfaction and higher member retention.

Watch Our Webinar

The 2019 AEP results showed a strong increase in supplemental benefits to improve marketability and management of specific health conditions for Medicare Advantage Plans.

In this HealthScape webinar, hosted by Convey Health Solutions, Cary Badger (Principal) discussed findings in relation to the newer and most popular supplemental benefits and how plans can use those benefits to engage members in their healthcare.

Topics discussed include:

      • The drivers of increased MA enrollment, and the impact relaxed guidance on supplemental benefits had on MA plans

      • The reason OTC coverage is one of the most attractive benefits across all new supplemental benefits

      • The discrepancy of OTC benefit offerings between national plans vs. regional, provider-sponsored plans and not-for-profit Blue plans

      • OTC delivery models available in the market (primarily the OTC benefit card and OTC home dleivery)

      • Plan strategies to attract Medicare Advantage members as more and more Boomers continue to age into Medicare coverage