Allergies are a chronic reaction of the immune system to allergens. Allergens could be pollen, grass, food, and other irritants.
Allergies can develop at any age, time and may even appear suddenly. In addition, they can be seasonal or year-round, and symptoms can range from mild to severe.
Therefore, you may need allergy tests and treatment to help with your condition.
However, knowing whether Medicare will cover your allergy testing and treatment is essential.
Does Medicare Cover Allergy Testing?
In short, it does.
However, you must meet the specific criteria below for Medicare Part B to provide coverage.
Eligibility for Allergy Testing
You and your healthcare provider must meet the following criteria for Medicare to cover the testing.
- Your physician must accept Medicare.
- Your healthcare provider must prescribe the allergy test.
- The allergy test must be medically necessary and have been documented by your physician as well.
- The testing must be performed in a Medicare-approved laboratory.
- No previous therapy has been able to manage your allergy or its symptoms.
- Your physician admits that allergy testing is a part of a complete Medicare-approved treatment program.
You might be eligible for allergy testing depending upon the criteria listed above.
However, it’s essential to understand that Medicare does not cover all allergy test procedures. And that’s where you have to consult your healthcare provider and plan provider to ensure whether Medicare covers your allergy testing or not.
You may also find that your allergy test is covered under Medicare Part C or Advantage but not covered under Part B. Thus, communicating with your plan provider is crucial.
What Tests Does Medicare Cover?
As we said earlier, tests covered by Medicare Part B may vary from those covered by Medicare Part C. Therefore, it is good to communicate with your plan provider first.
In general, the allergy tests covered by Medicare Part B are as follows;
Percutaneous (Skin) Test: The procedure tests the allergies related to substances such as pollen, insects, certain drugs, etc.
The physician will prick your skin and expose it to small amounts of protein found in those allergens. If you’re allergic to it, your skin will respond to it and develop a raised bump at the test area on your skin.
RadioAllergoSorbent Test (RAST) or ImmunoCAP (Blood) Test: In this procedure, your blood gets tested to identify the potential allergen antibodies. Your blood sample gets tested at a laboratory for evidence of possible allergens or allergen antibodies.
Food Challenge Testing: These tests are performed when an allergy to a specific food has to be tested. A physicist or allergist closely monitors the patient by giving them small amounts of food to ingest and looks for symptoms by gradually increasing food quantities.
Notably, this test is only covered when done on an outpatient basis.
Here are the following symptoms you should look out for and consult your primary care physician for allergy testing.
- Itchy, watery, or red eyes
- Sneezing accompanied by an itchy, runny nose or blocked nasal passages
- Wheezing, coughing, shortness of breath
- Hives that are red, itchy, and persistent
- Dry, cracked, red, and irritated skin
- Swelling of the face, eyes, lips, or tongue
Medicare Coverage for Allergy Treatment
Possibly there are many strategies that you can consider to treat your allergies. And avoidance from allergy triggers is one of them. However, in some cases, if allergies produce severe risk or conditions like asthma, medication and other treatments are required.
Therefore, you must know what kind of treatments Medicare covers.
Here are the following allergy treatments that Medicare covers.
Not every allergic reaction is severe and demands emergency care. Some prescription drugs like antihistamines are enough to do the job.
Notably, Medicare Part A and B do not cover prescriptions until medications are given at a health facility or doctor’s office.
However, Part D may help you with outpatient prescription drugs.
You can also consider Medicare Part C, which sometimes covers prescription drug costs if included in the plan.
Immunotherapy or Allergy Shots
Immunotherapy is recommended in the case of severe allergic reactions, as they are good treatment options.
However, whether Medicare covers them or not is a complex topic. Medicare does not have set guidelines to cover allergy shots. Therefore, it depends on case-by-case whether Medicare will approve the coverage or not.
Your physician must document that allergy shots are medically necessary for treating the allergies as the reaction is severe and no other treatment options have worked.
But before we proceed, let’s briefly understand what allergy shots are.
Allergy Immunotherapy shots help you become less sensitive to the allergen by introducing them to your body in small amounts for a more extended period, mainly until your body develops immunity against it.
Indeed, it takes time, and you might have to take shots for years. And if you stop taking shots, you might have to start all over again.
Coming to Medicare coverage for these shots, here’s how Medicare’s different parts provide the benefits.
Medicare Part B: If eligible, Part B may cover up to 80% of your allergy shots costs. You’ll pay your monthly premiums, deductibles, and out-of-pocket costs.
Check with your physician and the plan provider for coverage before scheduling the appointment.
Medicare Part C: Part C covers allergy shots, but the provided coverage may vary from plan to plan. You must check with your plan provider to know the costs and coverage for allergy shots. Your location and the coverage options may lead to different copays, deductibles, and premiums.
Medicare Part D: As we said earlier, Part D covers the outpatient prescription drugs except for the given medications and allergy shots at a doctor’s office.
Indeed, immunotherapy can be considered the best treatment option for allergies at the end. However, there’s no cure for allergies, and not every allergy can be treated with the help of allergy shots.
And even if you proceed, knowing that it will be helpful and may also produce allergic reactions after dosage, you must consult your plan provider and doctor to avoid unexpected costs and conditions.