Does Medicare Pay for Allergy Testing and Shots?
- Medicare Part B covers allergy shots if your doctor decides they are medically necessary. Part B also covers certain types of allergy testing. Learn more about Medicare coverage for allergy shots and allergy medication.
Medicare Part B covers allergy shots if your doctor says they are medically necessary. Part B also pays for certain types of allergy tests, and many Medicare Part D Prescription Drug plans cover allergy medications.
Below is a detailed look at how Medicare covers allergy shots, tests and medications, and how much it typically costs for allergy shots on Medicare.
When Does Medicare Part B Pay for Allergy Shots?
Medicare does not have specific guidelines about how it covers allergy shots and allergy treatments. Coverage decisions are made on a case-by-case basis and may depend on the types of allergies you have and their severity.
A doctor may determine your allergy shots are medically necessary for one of the following reasons:
- You experience severe symptoms or severe allergic reactions.
- You suffer from allergies that are chronic.
- Your allergies may lead to other complications such as asthma or respiratory illness.
- Other allergy treatment options have been ineffective.
If Medicare covers your allergy shot, you will typically pay a 20% coinsurance or copay after you meet your annual Part B deductible, which is $203 in 2021.
All Medicare Advantage plans are required by law to provide at least the same minimum coverage as Medicare Part A and B, so a Medicare Advantage plan will also cover at least 80% of the cost of your allergy shots if your doctor says they are medically necessary.
What Prescription Medications Does Medicare Cover for Allergies?
Over-the-counter allergy drugs are not covered by Medicare Part B. But prescription allergy medication may be covered by a Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage.
Each Part D plan and Medicare Advantage Prescription Drug plan (MA-PD) has its own formulary, which is the list of drugs covered by the plan. Each plan will also have its own requirements for deductibles, copayments and coinsurance, so the amount you will pay for Medicare allergy drugs will vary from one plan to the next.
What Types of Allergy Testing Does Medicare Cover?
Medicare Part B and Medicare Advantage plans may cover the cost of allergy tests under the following circumstances:
- A doctor who is enrolled in Medicare determines that an allergy test is medically necessary and writes a prescription for it.
- The allergy test takes place in a Medicare-approved lab.
- The patient’s allergies and allergy symptoms have not been previously managed by any therapy alternatives.
- The doctor documents that the allergy test is the first step in a complete allergy treatment program.
Medicare typically covers two types of allergy testing:
- Percutaneous testing, also called a “scratch test,” which introduces trace amounts of an allergen to the body to monitor the body’s reaction.
- Intradermal testing, which involves using a small needle to inject an allergen under the skin.
Medicare also covers services and items related to allergy treatment, such as nebulizers and medications for asthma. In addition, Medicare will typically cover appointments with your primary care physician and allergists.