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FAQs

Who qualifies for an OTC card in NYC? ›

Medicare Advantage OTC Cards provide additional resources to help cover the cost of specific items. To qualify for an OTC card, you must qualify for Medicare coverage. Cards are issued by your individual Medicare provider. Benefits are dependent on the type of Medicare plan you have.

Yes! Healthfirst Leaf Plans, Healthfirst Essential Plans, Healthfirst Medicaid Managed Care, and Healthfirst Child Health Plus are on NY State of Health.

Healthfirst provides FDA approved reversible birth control methods. These include: hormonal methods such as the birth control pill, patch, ring, shot, implant and emergency contraception.

Each Marketplace health plan has a unique 14-character identifier that's a combination of numbers and/or letters. You can find a plan's ID below the plan name when you preview plans and prices. If you've already enrolled in a plan, you'll find your plan's ID in your Marketplace account under "My Plans and Programs."

How do I check the balance on my OTC card? Once your card is activated, you should learn how to check your account details. You'll especially need to check your balance and the amount you've used. Most cards have a toll-free number listed on the back of the card, which you can call to find out.

You can have Medicare and Medicaid at the same time.

If you are under 21 years of age, over 65 years of age, certified blind, certified disabled, pregnant, or a parent of a child under 21 years of age, you may be eligible for Medicaid if your income is above these levels and have medical bills.

Weight loss has never been a Medicaid-approved reason for covering a drug. Drugs, including but not limited to Ozempic, Wegovy, Qsymia, and Mounjaro, are not covered by NYRx when prescribed for weight loss.

These rules clarified that the ACA and its implementation does require coverage for contraception and contraceptive counseling with no cost-sharing for people enrolled in group health plans and individual health insurance coverage.

Does Healthfirst cover contact lenses in NY? ›

Your allowance covers eyeglass frames, eyeglass lenses, and contact lenses. You can find a participating provider in the Health First Health Plans Supplemental Benefits Directory at hf.org/directory or you can contact Davis Vision directly at 1.800. 999.5431 (TTY:771).

For calendar year 2024, according to the latest approved rates data from the NY Department of Health, the average cost for a Bronze-level health plan in New York is $800 per month with a $4600 deductible. This represents a monthly premium 13.4% increase from 2023.

To shop in the Marketplace, you: Must live in New York. Must be a US citizen, national, or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid based on your income) Cannot be currently incarcerated.

There are no eligibility requirements for an OTC card. If your Medicare Advantage plan includes OTC credits, you can use them as the plan allows. A few things to note about OTC cards: Original Medicare doesn't provide any coverage for OTC items.

Your OTC benefit helps you save money on a wide range of over-the-counter health and wellness products. You can use your benefit amount to purchase products such as pain relief, first aid, cold and allergy medicine, dental care items and more.

The OTC benefit — a common ingredient of Medicare Advantage plans⁴ — means funds to spend at pharmacies for OTC products. It might come as an OTC card you can use at participating retail stores. With this coverage, you receive a certain dollar amount per year, per quarter or per month. (It varies by plan.)