Does Medicaid Cover Allergy Testing?
- Does Medicaid cover allergy testing? Discover how Medicaid and Medicare coverage for allergy testing works and whether Medicare covers immunotherapy treatment.
Allergy tests are tests carried out by a doctor or another health care professional to detect allergic reactions to substances such as food, medications or inhalants. There are several ways to check for allergies, including skin and blood tests, and your doctor will select the most effective method based on your symptoms and suspected triggers. Allergy testing is often an essential service, but it's not included in every health care plan. So, does Medicaid cover allergy testing? Below, you can find out how Medicaid and Medicare coverage for allergy testing works and who's eligible.
Does Medicaid Cover Allergy Testing?
Medicaid may cover medically necessary allergy testing, but coverage varies across states. Although there are certain mandatory services that all Medicaid policies must cover, states can decide whether and how to fund allergy testing. You should contact your state's Medicaid Agency to determine if your state covers allergy testing and who's eligible.
Medicaid provides more comprehensive coverage to children and young people under the age of 21, which is called the Early and Periodic Screening, Diagnostic and Treatment Services benefit. Therefore, children are likely to be eligible for allergy testing through Medicaid even if your state doesn't routinely fund allergy testing for adults.
If your state's Medicaid policy covers allergy testing, it may restrict the type or frequency of testing for eligible beneficiaries. For example, some states restrict the number of allergy tests a beneficiary can receive funding for over a set period.
Does Medicare Cover Allergy Testing?
Medicare Part B may cover medically necessary allergy testing in certain circumstances because it is classified as a clinical diagnostic laboratory service. Beneficiaries must meet the following eligibility criteria before Medicare considers funding allergy tests.
- A Medicare-enrolled doctor orders the tests, and the doctor accepts the assignment.
- The laboratory that processes the tests accepts Medicare assignments.
- Your doctor verifies that there is a medical necessity for allergy testing.
- Your allergic condition and symptoms can't be controlled with alternative treatments.
- Your allergy tests are part of a Medicare-approved treatment pathway.
Original Medicare doesn't cover every available allergy test, and you should check that the tests you need are covered before proceeding. Medicare may cover the following allergy tests if your doctor thinks you need them.
- Skin (percutaneous) tests to diagnose allergies to various substances, such as food, medication, insect stings and inhalants like pollen
- Blood tests to check the levels of antibodies released by the body when it encounters a suspected allergen
- Outpatient food challenge testing to check for reactions to food allergens
Do Medicare Advantage Plans Cover Allergy Testing?
Medicare Advantage Plans can be purchased through Medicare-approved private insurers. They provide the same benefits as regular Medicare, which means that they will cover any allergy tests covered by Medicare Part B if you're eligible.
Medicare Advantage Plans may include additional benefits not covered by Original Medicare, such as dental treatment, prescription drugs (Part D coverage) and vision care. Coverage varies according to provider, and some policies may cover allergy treatments not included in Medicare Part A or B. For example, Original Medicare doesn't cover acupuncture to treat allergies, but it may be included in certain Medicare Advantage Plans.
Does Medicare Cover Immunotherapy for Allergies?
Medicare may cover immunotherapy shots for allergies under Part B if they're administered in a Medicare-enrolled facility. To be eligible, your doctor must verify that you produce antibodies to specific allergens and that the duration and severity of your symptoms mean that the potential benefits of immunotherapy outweigh the risks.
Medicare requires that the antigens used for immunotherapy be prepared by a medical doctor or doctor of osteopathy. Your treatment and dosage plan must be set by the same doctor that prepares your antigen treatment. Your doctor can prepare up to 12 months of antigens at once, as long as they will remain stable and effective during that time. Medicare will withdraw funding for immunotherapy treatment for allergies if you don't see an improvement in your symptoms within 2 years.
Medicare usually requires a doctor to administer immunotherapy in a clinical setting. The clinic must have the facilities to treat anaphylaxis because it is a risk associated with the treatment. However, it may approve self-administration at home in exceptional circumstances. For example, you may be covered for self-administered immunotherapy if you have life-threatening allergies and live in a remote area.
You may also be eligible for support with meeting the costs of prescription drugs to treat your allergies if you purchase a separate Medicare Part D plan.
How Do I Get My Insurance to Cover My Allergy Testing?
Unfortunately, there is no way to guarantee that a health care plan or insurance policy will cover allergy testing. Most insurers and state and federal plans only cover medically necessary allergy testing. Therefore, your doctor needs to provide as much evidence as possible of your need for testing.
Your provider may restrict the types of allergy tests it covers, which means it may not fund your doctor's preferred testing regimen. In this situation, you may wish to consider asking your doctor if there is a suitable alternative covered by your policy.