Some types of allergy testing are covered by Medicare. In order to qualify for these tests, your doctor must:
- have a documented history of your allergic reactions
- show that you have significant symptoms that have not been controlled by other therapies
This article provides more information on Medicare’s coverage for allergy testing, including which tests are covered and how much they cost.
Medicare only covers allergy tests proven to provide accurate and effective results for specific types of allergens.
For example, Medicare typically covers percutaneous tests (skin tests that involve puncturing, pricking, or scratching) leading to IgE-mediated reactions to suspected allergens, such as:
- specific types of medications, such as penicillin
- insect stings or bites (Hymenoptera)
If the percutaneous tests show up negative, your doctor may suggest intracutaneous, or intradermal, testing.
These tests involve the injection of a small amount of an allergen into your skin. They may be covered by Medicare if IgE-mediated reactions occur to suspected allergens, such as:
- specific types of medications
- insect stings or bites (Hymenoptera)
Talk with your doctor to see if Medicare will cover your particular allergy testing needs and treatment. Usually, it comes down to your particular Medicare plan and your doctor’s certification that the testing is necessary, reasonable, and part of a treatment program that:
- is safe
- is effective
- has a duration and a frequency considered appropriate by Medicare
Allergy services typically fall under Medicare Plan B (medical insurance) or Medicare Plan D (prescription drug coverage).
Medicare Part B is part of original Medicare. The monthly premium for Medicare Part B is $144.60 in 2020. The annual deductible for Medicare Part B is $198 in 2020. Once you’ve paid those premiums and deductibles, Medicare typically pays 80 percent, and you pay 20 percent of approved costs.
Medicare Part D is outside of original Medicare. It’s purchased from a private insurance company that’s Medicare-approved. Part D typically covers the self-administered prescription drugs that aren’t covered by original Medicare. Premiums depend on the company from which you purchase Part D and the coverage your policy offers.
Medicare Part C(Medicare Advantage) is purchased from a private insurance company and bundles Part A, Part B, and often Part D into a single comprehensive plan. It may also cover extra benefits not offered by Medicare such as vision and dental care.
Ask your doctor if the test they’re recommending is covered by Medicare. If test is covered, ask your doctor how much it will cost.
How much you spend on an allergy test varies based on a number of things, such as:
- other insurance coverage, such as Medicare Advantage
- Medicare and other insurance premiums, deductibles, coinsurance, and copays
- doctor charges
- doctor acceptance of assignment (Medicare-approved price)
According to the Asthma and Allergy Foundation of America (AAFA), over 50 million people in the United States experience an allergic reaction every year.
An allergy is a reaction from your immune system to a foreign substance (allergen). An allergen could be something you:
- inject into your body
Your reaction could result in:
Allergies cannot be cured. They can, however, be managed with treatment and prevention.
Certain types of allergy testing are often covered under certain circumstances. That said, check with your doctor before undergoing an allergy test to make sure the test is covered under your Medicare plan, and to find out how much it will cost.
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