Different parts of Medicare offer coverage for allergy testing and related services.
According to The American Academy of Allergy, Asthma & Immunology (AAAAI), various types of allergies affect more than 50 million people annually in the United States.
In this article, we look at Medicare coverage of allergy diagnosis and treatment. Then we discuss costs, and the various types of common allergies.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare Part B (medical insurance) and Medicare Part D (prescription drugs) both offer 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 person has to pay a standard monthly premium, which is $144.60 in 2020, and an annual deductible, which in 2020 is $198.
Medicare Part D
Medicare Part D typically covers the self-administered prescription drugs that are not covered by original Medicare.
It is available through private insurance companies, and premiums and coverage depend on the plan details.
Medicare Advantage
Medicare Advantage is private insurance offered by Medicare-approved companies. A Medicare Advantage plan may offer additional insurance coverage including hearing, vision, dental, and wellness programs.
There are several Advantage plans, including:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service plans (PFFS)
- Point of Service (POS) plans
- Provider Sponsored Organizations (PSO)
- Medical Savings Account (MSA) plans
- Special Needs Plans (SNP)
If a person has Medicare Advantage, they can check with the plan provider for allergy tests the plan may cover.
The cost of treating allergies is more than $18 billion annually, according to the AAFA.
What is an allergy?
Allergies are classed as chronic diseases, which means they often occur, or may last a long time.
An allergy happens when a person’s immune system overreacts to a foreign substance it thinks is harmful. Those substances are called allergens. The person’s system then creates antibodies that react to allergens, and a person gets one or more symptoms.
What are common symptoms?
Symptoms can include a runny nose, sneezing, coughing, itchy skin, watery eyes, and skin rashes.
Substances that can cause an allergic reaction include:
- dust mites
- food
- insect stings
- latex
- medicines
- mold spores
- pet dander
- pollen
An allergen can include food, an inhaled or injected substance, or something that touches the skin.
Tests
To understand a person’s symptoms, a person’s doctor will ask questions about their medical history, and may also do a physical examination. Other tests may check how well a person’s lungs function and the doctor may ask for an X-ray.
A doctor may also do skin and blood tests to diagnose an allergy. Those tests may include:
- skin prick test (SPT)
- intradermal skin test
- patch test
- blood tests (specific IgE)
- challenge tests supervised by a doctor
Treatments
Allergy treatments may include allergy shots, medicine, 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 medicines as prescribed
- keeping a diary to keep track of possible allergens
- getting a prescription for an epinephrine auto-injector, to be prepared for a severe allergic reaction
- wearing a medical alert bracelet
If a person’s allergy symptoms are considered mild, they may be treated with over-the-counter medicine.
Medicare covers laboratory tests, including certain blood tests, tissue specimen tests, urinalysis, and some screening tests. Not all allergy tests are paid for by Medicare, so a person can ask their doctor which tests are covered.
Medicare costs include premiums, deductibles, and copays.
| Medicare Part | Costs |
|---|---|
| Part B | The standard premium is $144.60. A person’s income may affect the premium. |
| Part B deductible and coinsurance | The deductible is $198. |
| Part C | The premium varies among plans. |
| Part D | The premium varies among plans. |
A person can ask their doctor for the test costs, and if 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.
Allergens can cause many symptoms including a runny nose, sneezing, coughing, itchy skin, watery eyes, and skin rashes.
The six most common allergies include the following.
Nasal allergies
Nasal allergies, also known as hay fever, are classified as indoor or outdoor allergens.
Indoor allergens include dust mites, mold spores, pet dander, rodent dander, and cockroaches. Cockroaches contain a protein that can cause an allergic reaction in some people, usually those who live in the southern U.S. or in urban cities.
Outdoor allergens include weeds, grass, and tree pollen, and outdoor mold.
Skin allergies
Skin allergies include eczema, hives, skin inflammation, and contact allergies. Native U.S. outdoor plants such as poison ivy, poison sumac, and poison oak cause a skin allergy when touched.
Food allergies
Food allergies occur most often in children under the age of 18. Many children may outgrow a food allergy. Adults can also develop allergies to certain foods.
The most common food allergens include eggs, wheat, soy, milk, peanuts, tree nuts, fish, and shellfish.
Medication allergies
Some people may get an allergic reaction to prescribed medication. Medications that may cause an allergic reaction include:
- antibiotics (penicillin and others)
- ibuprofen, and non-steroidal anti-inflammatory medications
- anticonvulsants
- medication used during chemotherapy
- monoclonal antibody therapy
According to the AAAAI, a person may reduce the chance of an allergic reaction if they take the medication orally. When medication is taken by injection or applied to the skin, there may be a higher chance of a reaction.
Latex allergy
Latex is produced from the sap of rubber trees. The tree sap is combined with chemicals during many manufacturing processes. Latex is used in rubber gloves, balloons, rubber bands, and condoms.
Hospital items that may contain latex include:
- surgical and exam gloves
- catheters or tubing
- bedsheet protectors
- sticky tape or electrode pads that are attached to the skin
- blood pressure cuffs
- tourniquets
- stethoscopes
- elastic bandages and wraps
- medicine vials
Latex may cause a serious allergic reaction in some people. With repeated exposure, an allergic reaction to latex can worsen. An allergist or immunologist can diagnose and provide relief for latex allergy.
Stinging insect allergies
For most people, an insect sting causes temporary pain, redness, swelling, and itching. But if a person is allergic to insect stings, their body overreacts to the venom. For people with venom allergy, an insect sting may be life-threatening.
The 6 most common venomous insects that can cause allergic reactions are:
- yellow jackets
- honeybees
- bumblebees
- paper wasps
- hornets
- fire ants
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 also ask if the test is covered by their Medicare plan.