Does Medicare Cover Allergies?

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Allergies are your body’s way of fighting off allergens. Allergens can be found in food, medicines, insects, or the environment. If you come in contact with an allergen, you may have an allergic reaction. Allergic reactions can result in sneezing, hives, and death in severe cases.

According to the Asthma and Allergy Foundation of America (AAFA), seniors react more severely to allergens than any other age group. While most allergies can be easily managed, some people go on living with chronic uncontrolled allergies. If this sounds like you, you may be wondering if Medicare covers allergy testing and treatment.

Fortunately, Medicare does cover testing and treatment for allergies. However, depending on the type of test and treatment, you may have to meet specific requirements.

Does Medicare cover allergy testing?

Allergy testing allows your doctor to confirm which allergens you are allergic to. There are many forms of allergy testing, such as percutaneous skin tests, blood tests, and food challenges. If you suffer from chronic allergies, your doctor may recommend one of these tests. 

Medicare will cover your allergy test if your doctor attests:

  • you have a history of allergies uncontrollable by other treatments
  • the test is medically necessary
  • the test technique provides accurate results for the allergens being tested

Percutaneous skin tests are the most common form of allergy tests. This type of test involves pricking or scratching your skin with specific types of allergens, such as foods, inhalants, insect venom, and medicines to see if an immunoglobulin E (IgE) response occurs. 

IgE is a type of antibody that your immune system creates when you come in contact with an allergen. The antibodies release chemicals that then cause an allergic reaction. This is how your doctor confirms you have an allergy. 

Medicare may also cover intradermal allergy testing if the percutaneous test comes up negative. This type of allergy test doesn’t test for foods, though. Your doctor may recommend a food challenge test to further test for food allergies. 

Medicare may cover your food challenge test if it is deemed medically necessary and done on an outpatient basis. A food challenge test involves consuming a specific food at increasing amounts until you have an allergy reaction, or the doctor can rule it out as an allergy. 

Allergy treatments: medications and allergy shots

After your allergy test, your doctor may recommend allergy shots. Allergy shots can be used to treat chronic allergies. Medicare may cover your allergy shots if they are medically necessary. For example, if your allergies cause asthma, Medicare may consider your shots to be medically necessary. 

Because allergy shots are typically administered in a doctor’s office, Medicare Part B is in charge of coverage, not Part D. Medicare Part D, however, may cover other prescription medications to treat your allergies. Medicare Part D does not cover over the counter allergy medications, though. 

Medicare Part D allergy medication coverage

Medicare Part D is your primary source of prescription drug coverage while on Medicare. You’ll find that Part D plans cover pills, ointments, injections, and inhalers. The main difference between Part D and Part B drug coverage is that Part B covers drugs that are administered to you by a medical professional in an outpatient setting and are approved by Medicare. In contrast, Part D covers medicines you administer yourself.

Although Part D plans vary by carrier, they all must cover at least two medications from each drug class. For example, if you’re one of the 25 million people in the U.S. living with asthma, you’ll want to enroll in a Part D plan that covers your specific inhaler. If you enroll in a plan that doesn’t cover your inhaler, you could be out hundreds of dollars each month.

Conclusion

According to AAFA, allergies affect over 50 million Americans and are the sixth most common cause of chronic illness. If you suffer from chronic allergies, and cannot find relief in other therapies, talk to your doctor about allergy testing and allergy shots. Medicare may cover your testing and treatment.

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