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Medicare Offerings
   

 

HIGHMARK SENIOR MARKETS

 

 

 

Highmark Senior MarketsOver-the-Counter Benefit

 

Some of Highmark's Medicare Advantage plans feature a quarterly allowance that can be used to purchase non-prescription health and wellness items. Following are answers to some common questions about this useful benefit.

 

 

Which Highmark Medicare Advantage plans offer an OTC allowance benefit?

The following Highmark Medicare Advantage plans include an OTC benefit: 

 

Pennsylvania 

 

Community Blue Medicare HMO Signature

  • Western PA: $75 Allowance Once Per Quarter
  • Central PA (Carbon, Lehigh, Monroe, Northampton, and Schuylkill Counties Only): $125 Allowance Once Per Quarter

Community Blue Medicare PPO Distinct

  • Northeastern PA/Central PA: $125 Allowance Once Per Quarter
  • Lancaster County: $150 Allowance Once Per Quarter

Community Blue Medicare PPO Signature

  • Northeastern PA/Central PA: $100 Allowance Once Per Quarter

Complete Blue PPO Distinct

  • Western PA: $105 Allowance Once Per Quarter

Complete Blue PPO Signature

  • Western PA: $75 Allowance Once Per Quarter

Community Blue Medicare Plus PPO Distinct

  • Northeastern PA: $125 Allowance Once Per Quarter

Community Blue Medicare Plus PPO Signature

  • Northeastern PA: $100 Allowance Once Per Quarter

 

Pennsylvania plans that do not include the OTC benefit:Freedom Blue PPOSecurity Blue HMO-POSCommunity Blue Medicare HMO Prestige 

 

West Virginia

Freedom Blue PPO WV Distinct

  • $105 Allowance Once Per Quarter

Freedom Blue PPO WV Signature

  • $75 Allowance Once Per Quarter

Freedom Blue PPO WV Standard

  • Not Covered

Delaware

Freedom Blue PPO DE Distinct

  • $125 Allowance Once Per Quarter

Freedom Blue PPO DE Signature

  • $75 Allowance Once Per Quarter

 

How can members order OTC products online?

Members can visit the following web page to search and order OTC products:Highmarkotcstore.comTo login, Members will use their 12 digit member ID (numbers only). Their password is their date of birth in mmddyy format.Members are limited to one free shipment per quarter, so they should be encouraged to order all of their items at once.All products have an ordering limit of three units per quarter unless otherwise specified. 

 

How can agents order copies of the 2022 OTC catalog?

Agents can order the 2022 OTC Catalog via MarCom: 

  1. Login to the Producer Portal at medicare.highmark.com/producer/login
  2. Click Order Supplies - Over 65 under Quick Links
  3. Search "2022 OTC Catalog"

 

 You can also download a copy of the 2022 OTC Catalog by clicking here:2022 Highmark OTC Catalog

 

 

A note on COVID-19 OTC tests.

Last month, Highmark sent an email campaign to educate Medicare Advantage members on the latest coverage requirements around COVID-19 OTC tests.This campaign reminded members that original Medicare will not pay for at-home tests through the program, at this time.  Medicare members are still eligible for COVID-19 testing at no out-of-pocket cost when it is performed by a laboratory and ordered by an authorized health care professional.For more information, including FAQs about OTC test reimbursement, visit:Highmarkanswers.com