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Utilization and Oversight of Medicare Part C Supplemental Benefits for Over-the-Counter Items

Announced on  | Last Modified on  | Project Number: OAS-26-06-057
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicare Advantage (MA) plans may offer supplemental benefits, such as over-the-counter (OTC) benefits, to support enrollee health.  These benefits are funded through rebates and must be used on CMS-approved, health-related items.  In 2024, CMS required MA organizations to report utilization and cost data for OTC benefits.  However, MA organizations have varying approaches to delivering this benefit, and there is limited visibility into how funds are spent or whether all enrollees are able to access the benefit.  We will audit selected MA organizations to determine whether OTC benefits are being accurately reported to CMS and administered in accordance with Federal requirements.

TIMELINE

  • March 16, 2026
    Announced
  • Today
    Office of Audit Services In-Progress
  • Est FY2028
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Managed Care
Target Groups
-
Financial Groups
Medicare C