Does Medicare Cover Allergy Testing?
Medicare Covers a Specific List of Tests Available for Allergen Testing
Key Takeaways
Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive. covers medically necessaryHealthcare services that are necessary for the diagnosis or treatment of an illness, injury, condition, disease or symptoms. allergy tests when prescribed by Medicare-approved physicians
Medicare-approved allergy tests include skin, blood and food testing
Allergy shots, or allergen immunotherapy, are often covered by MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D).
If you’re one of countless older Americans suffering from allergies, Medicare Part B can help cover your allergy testing. Allergy testing must be medically necessary and prescribed by a Medicare-approved physician that accepts assignment. Medicare Advantage (Part C) beneficiaries may receive even more allergy testing benefits.
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Is Allergy Test Covered by Medicare?
There are several types of Medicare-approved allergy tests your doctor can perform if you qualify. Not all allergy tests are accepted by Medicare, however. Ensure your doctor verifies that your allergy testing meets the Medicare requirements if you need it covered by Part B. As a guide, Medicare typically covers the following types of allergy testing:
- Skin tests to examine your body’s allergic reaction to different substances, including pollen, pet dander, and more
- Intradermal tests under the skin if needed following standard skin tests
- Blood testing to examine your body’s antibodies
- Outpatient food challenge testing to determine your body’s food allergies
Does Medicare Pay for Allergy Skin Testing?
Skin testing is often covered by Medicare when an approved doctor prescribes it and is deemed medically necessary. Skin testing can detect whether you’re allergic to everyday things like pollen, dust and more. If your doctor prescribes a skin test, you may have to pay your Part B deductible and a copay.
Medicare Advantage may provide different benefits for allergy tests but must provide at least the same level of coverage as Original Medicare’s Parts A and B. You may be responsible for other charges when you receive a skin test.
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Is Allergy Immunotherapy Covered by Medicare?
If you suffer from allergies, your doctor may determine you need allergy immunotherapy treatments or allergy shots. Medicare typically decides whether to cover this service on a case-by-case basis. [i] If your doctor prescribes immunotherapy treatment, and your Part B does not cover it, you could wind up paying 100% of the costs.
Does Medicare B Pay for Allergy Shots?
Medicare can pay for a portion of your allergy shots if a doctor determines allergen immunotherapy is medically necessary. If you qualify for coverage, Part B will often pay 80%, leaving you with a 20% copay once your deductible is met.
Part C may also cover your allergy shots. Medicare Advantage plans offer at least the same Part B coverage, but you may have different copays and coinsurance based on your plan’s details. If you have to see a different doctor or a specialist for your allergy treatment, make sure that the provider is in your Medicare Advantage network, or you could wind up paying for 100% of the costs.
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