How Does Medicare Cover Allergies?

 

There are roughly 50 million people in America affected by allergies. Allergies are reactions that your immune system has to particular substances that disrupt your system. Reactions can vary. Some reactions are mild while others suffer severe reactions when they are exposed to certain substances.

Allergy treatments also vary depending on the type and severity of the reaction. With 10,000 Baby Boomers aging into Medicare on a daily basis, tens of thousands of Americans need to know how Medicare will cover them and their allergies.

Luckily, Medicare can provide some relief.

Allergy Testing

Medicare covers two types of allergy tests: percutaneous allergy tests and intradermal allergy tests. Each test is performed differently and tests for different things.

For allergies to insect bites and stings, foods, certain prescription drugs, and inhalants such as mold and dander, a percutaneous allergy test is usually required to diagnose specific allergens. Intradermal allergy tests identify allergies to certain drugs, insects that sting, and inhalants.

Medicare only covers these forms of allergy tests on a case-by-case basis. However, doctors who specialize in allergy tests generally understand the medical necessity requirements and will only perform tests when they believe Medicare will cover them.

It’s crucial for all Medicare beneficiaries to understand that Medicare only pays 80 percent of allowable charges after you’ve met your deductible. The remaining 20 percent is your responsibility.

Allergy testing is normally an outpatient procedure, so it’s covered by Part B. Part B also covers any medically necessary allergy treatment including immunotherapy and allergy shots.

Allergy Shots

Medicare covers medically necessary allergy shots. Allergy shots are custom immunotherapy made specifically for you and based on what your test results show you’re allergic to. If your allergy tests show positive IgE reactions, your treatment and shots are usually covered under Medicare.

Testing for Food Allergies

For those with food allergies, it is good to note that Medicare will cover diagnostic tests. For instance, challenge ingestion food testing is generally covered under Medicare if it is medically necessary. Food challenge testing measures your body’s response to different foods over time.

Out-of-Pocket Costs

Allergy testing and treatments can require multiple visits over a fairly long period of time. If you don’t have a Medigap plan, you’re on the hook for 20% of the cost every time you see the doctor or get an allergy shot. It can really add up over time.

Medicare Plan G covers all your Medicare cost-sharing amounts except the Part B deductible. All you will have to cover out-of-pocket is $185, and your Medigap plan covers the rest.

If you are one of the 50 million Americans with allergies and are approaching retirement, you may be worry whether Medicare will cover your treatment. Contact your Medicare insurance broker or insurance carrier directly if you have questions about what Medicare will and will not cover for your allergy treatment and testing.