Your customer’s OTC and healthy benefits cards work differently in 2026 from how they worked last year. This may change what items a customer can buy at checkout, even if they used the same card last year. Our mission is to make sure our retailers, partners, and their communities have all the information they need to manage these changes. This article is the first in a series created for this purpose- to discuss ongoing changes to OTC and Healthy Food benefits.
These articles will contain the most up-to-date information that we have. We will do our best to share new information as we learn it, and release new articles accordingly.
In 2026, Medicare changed how it issues OTC and healthy food benefits. The new model requires the member to have one or more long-term health conditions (chronic conditions) to qualify for healthy food benefits. Many Medicare members do, so these members will keep their benefits - members without chronic health conditions will not be able to purchase healthy foods with their benefits.
Benefit amounts and rules change from year to year. These are set by health plans and benefit processors to match Medicare and Medicaid rules—not by ProHealth Connect (PHC). This year’s changes are quite big, and will impact many shoppers.
That’s why a customer who used both Over-the-Counter (OTC) and Healthy Food benefits in 2025 might only have OTC in 2026.
PHC does not get member lists of what benefits a customer has on their card. Stores and PHC usually cannot know a customer’s exact benefits ahead of time. Because of that, your PHC app checkout screen on ProHealth Pay, Link, or Go is now the best way to see what benefits members have.
One benefit card can have one or more benefit purses. A benefit purse is a bucket of money that can only be used for certain items.
Common purse codes you may see*:
'OTC’ and ‘HFE’ codes are the codes most relevant for eligible products in the ProHealth Connect system. Rewards programs may also provide health food and OTC benefits depending on the plan
*IMPORTANT: This list is not complete and can change. PHC does not create or maintain these codes.
The purse codes decide what items are approved. Only a matching code can pay for matching items. Even if several codes show, each purse works on its own.
A [NO BENEFITS] result after you correctly scanned/swiped a card the card means the card does not have funds available in the correct purse for the items being purchased. This does not mean there's no money on the card.
You might see this result when the customer has already spent their eligible benefits, or that the member does not have the appropriate OTC or HFE benefit needed for their items.
As an example, to buy a gallon of milk, a member must have a benefits card that shows ‘HFE’ (Healthy Food). If HFE does not show, the purchase may decline with [NO BENEFITS],” even if the card has money in a different purse (like OTC).
When this happens, the customer should call their health plan using the phone number on the back of their card.
Sometimes a code can start with a plan label, like “UHC.” In a busy lane, that label can look like a benefit code. We know that your stores can get busy and lines can create pressure for cashiers. Taking a moment to read the full code will prevent confusion and save time in the long run.
We know these 2026 changes can be confusing at checkout. ProHealth Connect is here to support you as you support your community, and more articles on this topic will be coming. Keep an eye on the PHC Community Page for more information
Questions? Email support@prohealthconnect.com or call our Support Team at 718-791-9733
