Medicare and Allergies – How are you covered?

*Guest Post by Danielle Kunkle (Forbes finance council as their Medicare expert)

Over 50 million Americans have some form of allergies such as skin allergies, asthma, food allergies, and one of the most common, hay fever. 

Hay fever, properly known as allergic rhinitis, affects over 25 million Americans. That’s half of the 50 million mentioned above. Usually, people who suffer from one form of allergy also suffer from another form as well. For instance, many people who have eczema also have asthma. 

Some allergies can cause anaphylactic shock and are life-threatening. Others may not be as serious but can still be a burden to deal with. Many people have resorted to allergy shots to manage their chronic allergies. 

Medicare may cover your allergy testing and allergy shots. Here’s how.

Allergy Testing

There are a few different types of allergy tests. There are two types of skin tests that test for allergies, and those are patch tests and intradermal tests. The main difference between the two is patch tests just require the allergen to be placed on top of the skin, while intradermal testing requires a small amount of the allergen to be injected into the skin. You can also test allergies with a blood test.

The primary rule of Medicare coverage is that the medical service needs to be medically necessary. For an allergy test to be considered medically necessary, your doctor needs to show proof of allergic reactions in your medical history. He or she will also have to document that your symptoms are not controllable by other treatments or therapies.

The type of reaction you get from your allergy test will also help Medicare determine whether or not coverage is granted. For instance, Medicare may cover a skin allergy test if you have immunoglobulin E (IgE) allergic reactions to the allergens. 

Allergy tests are considered to be diagnostic tests. Medicare Part B covers medically necessary diagnostic tests. You will be responsible for a $185 deductible (2019) each year under Part B. Once you have met that, you will be responsible for 20 percent of the bill, while Part B will cover 80 percent.

Allergy Shots

Allergy shots are custom immunotherapy made specifically for you based on what your test shows you to be allergic to. If the results of your allergy test are IgE reactions, then Medicare may cover your allergy shots as well. Medicare only covers allergy shots when they are prescribed by your doctor and the shots are deemed medically necessary to manage your allergies.

Allergy shots are usually given in a doctor’s office by a medical professional. When medication is given in this manner, Medicare Part B dictates coverage. Because allergy shots are given in a clinical setting and are a patient-specific formula, Medicare Part D doesn’t cover them. 

Medicare Part B nor Part D cover over-the-counter (OTC) medications. OTC medications are a popular treatment option for people who suffer from allergies. However, taking OTC medication on a daily basis can be more expensive than immunotherapy according to the chief of allergy and immunology at the Queens Long Island Medical Group, Myron Zitt, MD.

Another allergy therapy that Medicare doesn’t cover is sublingual drops. According to the Centers for Medicare and Medicaid Services (CMS), this form of therapy isn’t a safe and effective way to manage allergies. 

Food Allergy Testing

A common test for diagnosing food allergies is the challenge ingestion food test. While this test is being conducted, a small amount of a specific type of food is added to your diet and is increased over time. 

Medicare covers this type of food allergy test as a diagnostic test if your medical history proves it to be medically necessary. You will pay for this test just like you would for a skin allergy test.

How to Cover Out-of-Pocket Costs

Paying 20 percent of a diagnostic test can take a toll on your bank account. Instead of having to worry about how you will afford your allergy test, consider a Medicare plan such as a Medigap Plan G

Medicare Plan G covers all your Medicare cost-sharing amounts except the Part B deductible. Therefore, all you will have to cover out-of-pocket is $185, and then your Medicare and Medigap plan covers the rest. 

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