If you’re affected by allergies, Medicare coverage could help cover the cost of doctor and laboratory services necessary to make you feel better. When your doctor prescribes allergy testing, it’s important to understand how your Medicare insurance works for those and allergy shots.

The information below will tell you everything you need to know about Medicare coverage for allergy testing, shots, and medication.

Does Medicare Cover Allergy Testing?

Medicare Part B may cover allergy testing if you meet specific criteria. Allergy testing must be done in a facility that accepts Medicare assignments and prescribing doctors must be enrolled in Medicare.

Allergy tests will have coverage since they are part of the “clinical diagnostic laboratory services” category. Part B will cover your allergy testing when your physician prescribes an allergy test that is medically necessary and has documentation to prove it. Your physician may need to prove this test is part of a Medicare-approved treatment plan.

Some allergy tests won’t be covered by Medicare. You can talk to your doctor and Medicare to understand more about how tests will be covered.

Which Allergy Tests Will Medicare Cover?

For the most part, Medicare will cover skin procedures, blood testing procedures, and food challenge testing. It’s best to talk to your doctor about your symptoms to discuss which tests make the most sense for your situation.

Coverage will mostly apply to allergy tests that provide effective and accurate results for specific allergen types. Skin tests or percutaneous tests can show allergies to inhalants, medications, insects, or food.

If the skin test comes back negative, blood testing could be something your doctor recommends.

When it comes to coverage, Medicare wants to see that the treatment program is effective and safe. Also, the duration of treatments must be Medicare compliant.

Talk to your doctor about treatment options for you.

Will Allergy Treatments Be Covered By Medicare?

Yes, Medicare will cover allergy treatments. Specifically, Part B can cover items and services relating to allergy treatments like nebulizers and health care provider appointments.

What Does Medicare Cover for Allergy Shots?

Allergy shots will have coverage if your doctor says they are medically necessary. When Medicare agrees to cover the allergy shot, you’re still responsible for 20% of the cost after you meet your Part B deductible.

When it comes to allergy shots, Medicare coverage is on a case-by-case basis. You could have to show proof that other treatment methods do not work.

Will a Medicare Plan Help Pay for Allergy Testing and Shots?

Medicare plans help your Medicare go further and do more for you. Medigap plans can cover the gaps in Medicare, meaning you have lower out-of-pocket costs when you go to the doctor, specialist, or other health care facility. Some supplement plans cover your deductibles and coinsurances so you can focus on other things, like which doctor will help you best.

Sometimes Medicare plans such as Part C plans will cover more than traditional Medicare. Some Medicare Advantage plans cover over-the-counter medications, such as allergy medications.

Many Part C plans include things like prescription drugs and benefits beyond Medicare. Talk to your plan about the options they provide.

A Part D Prescription plan will have a formulary that includes a list of allergy medications covered by the plan. Each plan has its own list of covered drugs that come with its own deductibles, copayments, and coinsurances.

Almost every time, working with a licensed insurance agent makes choosing insurance easier.

FAQs

How often does Medicare cover allergy testing?

If an Allergist suggests medically necessary retesting, Medicare is likely to approve the testing. Generally, a specialist will test you every two years if testing is necessary. When it comes to allergies, coverage is on a case-by-case basis.

Does Medicare cover food sensitivity testing?

Food challenge tests that are medically necessary will likely have coverage, these tests usually occur in an outpatient facility or hospital.

Does Medicare cover allergy medications?

Original Medicare doesn’t cover allergy medications, but Part D prescription drug coverage will help cover the cost of your prescriptions.

How to Find the Best Medicare Plan for Your Needs

If your allergies are bad and you seek relief, supplemental Medicare plans could truly work to cover the gaps in your current coverage.

Our licensed insurance agents can assist you in picking the best plan for your individual needs while also answering any of your questions.

To find the best Medigap plan for your needs, give us a call. You can also fill out our online rate form to receive the best rates in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.