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The OTC benefit isn't showing

Why the Medicare Advantage OTC estimate may not appear.

Written by Josh Channin

The Medicare Advantage OTC benefit estimate only appears when certain conditions are met.

Common reasons it's missing

  • No active EHR session. The benefit is resolved from coverage information available during a connected session.

  • Coverage didn't resolve. If the patient's plan or benefit details aren't available, the estimate is skipped.

  • The plan isn't a Medicare Advantage plan with an OTC allowance.

What to expect

When the estimate can't be resolved, the workflow continues normally without it. The benefit is informational, and patients apply it at Walmart checkout.

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