- Allergy shots may help improve symptoms of severe chronic allergies.
- Medicare Part B covers most of the cost of allergy shots if they’re deemed medically necessary.
- The cost of allergy shots depends on what type of plan you have.
Allergies are a chronic immune reaction to allergens like pollen, grass, food, and other irritants.
Allergies can develop at any time or any age, and even sudden reactions are possible. They can be seasonal or year-round, and symptoms can range from mild to severe.
Allergy shots can provide relief from your symptoms when other treatments don’t help. Medicare Part B and Part C may cover a majority of the cost for allergy shots if your doctor believes they’re medically necessary.
Let’s find out when allergy shots may benefit you and how much they might cost with Medicare.
If you have severe allergies, immunotherapy allergy shots may be a good treatment option. However, the cost and multiple office visits can make it difficult to continue as a long-term therapy.
Medicare doesn’t have set guidelines on coverage for allergy shots. That means coverage decisions are made on a case-by-case basis by Medicare plans.
Your doctor must document that allergy shots are medically necessary because your symptoms are severe and other treatment options haven’t helped.
Medicare Part B
Medicare Part B is medical insurance for outpatient services. It may cover up to 80 percent of your allergy shot costs if eligibility requirements are met.
You’ll also pay your monthly premiums, deductibles, and out-of-pocket costs.
Shots are given at the doctor’s office, and you may have separate copays with each visit. Check with Medicare and your doctor’s office before your appointment to find out what your out-of-pocket costs will be.
Medicare Part C
Medicare Part C, or Medicare Advantage, plans may also cover allergy shots, but the amount of coverage varies by plan. Part C is required to cover at least as much as Part B.
You can check with your plan provider to ask about costs and coverage for allergy shots.
Your copays, deductibles, and premiums may differ depending the coverage options you choose and your location.
Medicare Part D
Medicare Part D plans cover prescription medications that you take at home. Since allergy shots are given at a doctor’s office, they typically won’t be covered under a Part D plan.
The cost of allergy shots can vary based on your plan’s coverage and out-of-pocket costs. It’ll also depend on whether you meet Medicare’s eligibility requirements.
When starting treatment, you’ll typically get two shots per week for 6 months. There are two parts that factor into your costs:
- the allergen serum itself
- administration fees for the doctor and medical facility
Without insurance, shots may be $1,000 to $4,000 each year — or higher when you first start treatment. During the maintenance phase, you’ll receive a shot once or twice per month for 3 to 5 years, so your costs will come down then.
Costs with Part B
If your doctor says allergy shots are medically necessary and Medicare approves coverage, Part B will pay 80 percent of the costs. You’ll pay the remaining 20 percent out of pocket, plus any additional copays.
This could mean paying up to $1,000 yearly in the initial phase but much lower costs in the maintenance phase.
With Part B, it’s important to visit providers who participate in Medicare and accept assignment to avoid higher costs.
Costs with Part C
Part C plans may also cover allergy shots, but coverage and cost can depend on the plan and include copays and coinsurance. Since costs can vary, check with your plan ahead of time about the exact amount you’ll need to pay for your immunotherapy injections.
Part C plans may have in-network providers, so be sure to see covered providers for allergy testing and shots. This is especially important if you live in an area with limited access to allergy and immunology specialists for testing and shots.
Costs with Medigap
Since shots are needed several times over the course of a year, a supplemental plan through Medigap may help offset some of your out-of-pocket costs.
There are 10 different Medigap plan options. You can search plans offered in your area and decide which is the best option for your needs and budget.
Allergy immunotherapy shots help make your body less sensitive to allergen triggers by introducing them in small doses over time.
Allergy shots don’t work right away or for all types of allergies. Most people must take shots for several years to see long-term benefits.
Allergy shots may help improve severe symptoms of these common types of allergens:
- Seasonal: pollen, grass
- Indoor: mold, dust mites, pet dander
- Insects: stinging insects, such as bees or wasps
The first step to learn more about your allergies is to get tested. Medicare Part B plans cover some types of allergy testing. Your doctor will need to show you have severe symptoms not controlled by other medication therapies.
Medicare covers skin tests for allergies from:
- stinging insects
What should I expect when receiving allergy shots?
It’s important to keep in mind that allergy shots take years to work, and you must visit a doctor’s office for each shot. If you stop getting the shots, you may have to restart the process, depending on how long you received shots.
Most reactions to allergy shots are mild because small doses are introduced over a long period of time.
Common reactions may include:
- redness, swelling, or irritation at the injection site
- nasal congestion
Some people may have a serious reaction, known as anaphylaxis, which can be fatal if it’s not treated right away. That’s why allergy shots are given at the doctor’s office, where they’ll monitor you for 30 minutes afterward to make sure you don’t have a severe reaction.
Anaphylaxis symptoms include:
- abdominal pain
- slurred speech
- facial swelling
- difficulty breathing
- difficulty swallowing
Since costs, time, and possible reactions can play a big role in staying the course with allergy shots, it’s important for you and your doctor to make a
Immunotherapy can help with long-term management of some types of chronic severe allergies. There’s no cure for allergies, though, and allergy shots don’t work for all types of allergies.
Different parts of Medicare may cover some of the costs of your allergy shots, but it’s important to check with your doctor and plan ahead of time to avoid unexpected costs.
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