Does Medicare Cover Allergy Testing?

March 31, 2021
4:19 pm

Does Medicare Cover Allergy Testing?

Allergies (whether environmental, food-related, or seasonal) will most likely affect you at one point in your life. In fact, the Allergy and Asthma Foundation of America reports that allergies affect more than 50 million Americans annually.

While there is no allergy treatment, your physician may recommend and prescribe a wide range of allergy tests and allergy shots to manage your condition.

So, does Medicare cover allergy testing? Here is everything you need to know about Medicare and allergy testing, including the specific tests covered and the costs involved.

So let us get started.

Understanding Allergies

Before we dive deep into our discussion, let us define what an allergy is and how it occurs.

Typically, an allergy occurs when your body reacts to various substances in the environment that are harmless. These substances are known as allergens and can be found in pollen, pet dander, insects, food, mold, and even some medications.

Atopy refers to the generic tendency of developing allergy diseases. It means that when atopic people are exposed to different allergens, they can easily develop an immune reaction that leads to severe allergic inflammation.

Common symptoms of allergic reactions include:

Coughing
Sneezing
Itchy eyes.
Scratchy throat.
Running nose.

Allergy Tests

To understand your allergy better, your doctor may ask a few questions about your medical history and conduct a physical examination as well. Other tests are designed to check how well your internal body organs, such as lungs and heart function, and your doctor may request an X-ray.

Your doctor may also conduct skin and blood tests to diagnose your allergy and determine its severity. The skin and blood tests include:

Intradermal skin test.
Skin prick test.
Patch test.
Blood tests (specifically lgE).
Challenge tests that are closely supervised by a qualified doctor.

What Allergy Tests Does Medicare Cover?

Medicare only covers allergy tests that are fully proven to provide accurate and effective results for managing specific types of allergy.

For instance, Medicare covers percutaneous tests leading to lgE-mediated reactions to suspected allergens such as inhalants, food, insect stings, and specific types of medications.

PS: Percutaneous tests are skin tests that involve pricking, scratching, and puncturing your skin to establish the severity of the specific allergic reaction.

If percutaneous tests turn negative, your doctor may suggest intradermal or intracutaneous testing. These tests are conducted by injecting a small and controlled amount of the allergen into the skin.

Medicare will cover such tests if IgE-mediated body reactions occur to the suspected allergens such as insect stings, inhalants, and specific types of medications.

Make sure you consult with your doctor to establish whether Medicare covers your allergy testing needs and treatment. In most cases, it comes down to your specific Medicare plan and your primary doctor’s certification that you need testing.

Medicare will only cover the costs if the recommended treatment program is safe, effective, and has a duration frequency that is considered appropriate by the Medicare team.

Medicare Coverage of Allergy Testing and Treatment

Allergy testing and treatment typically falls under Original Medicare Part B, and Medicare Part D. Medicare Part B offers medical insurance while Medicare Part D covers prescription drugs.

Allergy Testing and Treatment under Medicare Part B

Original Medicare Part B may help cover the cost of allergy testing and treatment if the following conditions are fulfilled:

The physician prescribing the allergy test must be enrolled in Medicare.
Your allergies and related symptoms must not have been managed by other therapy alternatives.
The doctor must provide sufficient evidence and documentation showing that the allergy test is medically necessary.
The allergy testing must take place in a Medicare-approved laboratory.
The doctor must also provide clear documentation showing that the testing is part of a complete treatment plan.

For you to qualify for allergy testing under Medicare Part B, you must be paying the monthly premium, which is $148.50 for 2021 for individuals and couples who earn less than $88,000 and $176,000 per year, respectively.

Medicare Part D (Prescription Drug Plan) Allergy Testing and Treatment Coverage

Medicare part D isn’t part of Original Medicare. It is a prescription drug plan purchased from private insurance companies that are Medicare-approved.

Medicare Part D usually covers self-administered prescription drugs that are not covered by Medicare Parts A and B. Monthly premiums for Part D vary from one provider to another and depend on the type of drugs covered.

Does Medicare Part C (Medicare Advantage) Cover Allergy Testing and Treatment?

Medicare Part C, commonly referred to as Medicare Advantage, is a private insurance cover offered by Medicare-approved insurance companies.

In most cases, Medicare Advantage plans offer additional insurance coverage, including vision, hearing, dental, and health wellness. The common types of Advantage plans include:

Health Maintenance Organizations (HMO).
Point of Service (POS) Plans.
Preferred Provider Organizations (PPO).
Provider Sponsored Organizations (PSO).
Special Needs Plans (SNP).
Private Fee-For-Service Plans (PFFS).
Medical Savings Account (MSA) plans.

If you have a Medicare Advantage plan, make sure you check with your plan provider for allergy tests covered under your plan.

What Is the Cost of Allergy Testing on Medicare?

The first thing you need to do is ask your primary doctor if Medicare covers the prescribed test. If the allergy test is fully covered, ask how much it will cost.

Typically, the amount of money you spend on allergy testing will vary significantly depending on a wide range of things such as:

Doctor charges.
Medicare and other insurance premiums such as coinsurance, deductibles, and copays.
Doctor acceptance of assignment or the Medicare-approved price.
Other insurance coverage such as Medicare advantage.

Final Thoughts

Typically, you may get Medicare coverage for certain types of allergy testing, although circumstances, plans, and costs may vary significantly.

You can always check your eligibility and the cost of testing with your doctor. Make sure you ask your primary doctor if your current Medicare plan covers the prescribed allergy test.

Do you have any queries about your Medicare coverage and need expert assistance? Our experienced and licensed Medicare experts at insurance are always ready to help you.