Medicare Part B may cover some types of allergy tests if a person meets certain criteria. Allergy testing falls under the “clinical diagnostic laboratory tests” category for Medicare.
To qualify for allergy testing under Medicare Part B, a person must work with a doctor to show:
- a documented history of allergic reactions
- a history of significant symptoms that other therapies are unable to control
This article provides more information on Medicare’s coverage for allergy testing, including which tests are covered and how much they cost.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare Part B (medical insurance) offers coverage for allergy testing and related services.
Original Medicare
Original Medicare Part B may help pay for allergy testing.
The following criteria must be met:
- The doctor prescribing the test must be enrolled in Medicare.
- Allergy testing must take place in a Medicare-approved lab.
- The doctor must provide documentation showing the test is medically necessary.
- The person’s allergies and symptoms must not have been managed by previous therapy alternatives.
- The doctor can prove the test is the first step in a complete treatment program.
A standard monthly premium applies, which is $174.70 in 2024, and an annual deductible, which is $240 in 2024.
A person will usually pay 20% of the cost for each Medicare-covered service or item after paying the deductible.
Medicare does not pay for all allergy tests, so it is important to know which test types are covered.
It is best to consult a physician before testing to ensure that a person’s Medicare benefits plan will pay for a specific procedure.
Medicare Advantage
Medicare Advantage is private insurance offered by Medicare-approved companies. Premiums and coverage depend on the plan details, so a person should check whether or not their plan covers allergy testing.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare only covers allergy tests proven to provide accurate and effective results for specific types of allergens.
Examples of allergy testing procedures that Medicare covers include:
- Percutaneous (skin) procedures: These test the skin’s reaction to substances such as pollen, animal dander, food, insect stings, and other agents. To do this, a medical professional marks the skin with a graph before pricking the skin and applying different allergens. They then record the skin’s response.
- Blood testing procedures: These measure antibodies in the blood that are released when the body comes into contact with specific allergens.
- Food challenge testing: A person consumes increasing amounts of a suspected food allergen until there is a reaction or the doctor can rule out an allergy. Medicare covers this when the testing is done on an outpatient basis.
Medicare covers clinical laboratory tests. These may include certain tissue and blood tests, urine tests, and some screening tests.
As Medicare does not cover all allergy tests, it is a good idea to ask a doctor which tests are covered.
Medicare costs include premiums, deductibles, and copays.
| Medicare part | Costs in 2024 |
|---|---|
| Part A premium | The premium is $0 for most but up to $505 each month if a person does not qualify. To qualify, a person must have paid Medicare taxes long enough while working. |
| Part A deductible and copayments | The cost is $1,632 for each hospital admission per benefit period. |
| Part B premium | The standard premium is $174.70. A person’s income may affect the premium. |
| Part B deductible and coinsurance | The deductible is $240 and 20% of the cost for each Medicare-covered service or item. |
| Part C | The premium varies among plans. |
| Part D | The premium varies among plans. |
A person can ask their doctor what the test costs and whether the recommended test is covered by Medicare.
In addition, if a person has coverage through Medicare Advantage or Part D, then the plan premiums, deductibles, coinsurance, and copays will affect cost.
A person can use this online tool to check the costs of various plans.
Medicare covers treatments and medications for most types of allergies. The costs and coverage criteria may vary, so it is best to consult a doctor or insurance provider about which treatments are covered.
Allergy treatment medications will fall under Medicare Part D, the section that covers prescription drugs. Allergy medications include corticosteroid nasal sprays, antihistamines, decongestants, and epinephrine injections.
Other allergy treatments may include immunotherapy and avoiding the substance that causes the allergic reaction.
A person’s doctor may also suggest a plan to manage or prevent a recurrence of the allergies. Other recommendations may include:
- taking medications as prescribed
- keeping a diary to track possible allergens
- getting a prescription for an epinephrine auto-injector in case of a severe allergic reaction
- wearing a medical alert bracelet
If a person’s allergy symptoms are mild, over-the-counter medication may be enough to control symptoms.
Asthma and allergy resources
To discover more evidence-based information and resources for living with asthma and allergies, visit our dedicated hub.
A person may get Medicare coverage for certain types of allergy testing, although plans, circumstances, and costs may vary. A person can check the test cost with their doctor and ask if the test is covered by their Medicare plan.