Yes, Medicare covers allergy testing if ordered by a Medicare-approved doctor. Allergy testing falls under the clinical diagnostic laboratory services category, which Original Medicare covers. This means if you’re experiencing symptoms of allergies, such as itching or congestion, Medicare Part B will pay for 80% of the costs if your Medicare-approved doctor prescribes allergy tests to determine the cause of your symptoms.
Remember that Medicare does not cover all allergy tests, so always double-check with your health insurance provider for specific coverage details.
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What You Need to Know About Allergies
Allergies are when your body’s immune system reacts to foreign substances in the environment, such as pollen, animal fur, and foods, that usually do not cause a reaction in most people. When you come into contact with the allergen, you may experience symptoms such as:
- Runny nose
- Itchy skin
- Watery eyes
- Coughing
- Swollen throat
- Hives
- Difficulty breathing
The severity of allergies varies depending on the person, but it could be life-threatening in some cases. If you have any of the above symptoms, your physician may order an allergy test to determine the cause. This way, you and your doctor can identify your allergy triggers and better understand how to manage your symptoms.
Understanding Medicare Coverage for Allergy Tests
Medicare Part B typically covers diagnostic tests ordered by your physician, including allergy testing. However, not all allergy tests are medically necessary, so always check with your doctor to ensure Medicare Part B pays for the specific procedure.
If Original Medicare does not cover the specific allergy test you need, consider looking into Medicare Advantage Plans since they may offer additional coverage for allergy testing.
If you need prescription drugs or allergy medication to ease your symptoms, Medicare Part D may help pay for some of the costs, but the coverage varies depending on your specific plan.
Eligibility
Medicare Part B may cover allergy tests if you meet the following criteria:
- Your doctor who’s prescribing the test must be enrolled in Medicare.
- Your doctor must provide documentation showing the test is medically necessary.
- Your doctor must show that no previous therapy alternatives or treatments have been able to manage your allergies or symptoms.
- The allergy testing must take place in a Medicare-approved lab.
- Your doctor can prove the test is the first step in a complete treatment program.
Remember that Medicare Part B may not cover all allergy tests even if you meet the above requirements. So always check with your doctor and health insurance provider to understand which tests are covered and how.
Covered Tests
Medicare Part B generally covers three types of allergy tests: Percutaneous procedures, blood testing procedures, and food challenge testing.
- Percutaneous Procedures: Percutaneous (scratch, prick, or puncture) procedures are typically the preferred method for testing your reaction to substances such as inhalants, food, insect stings, medication, or other agents. In percutaneous procedures, small amounts of suspected allergens are injected under the surface of your skin to test your reaction to them.
- Blood Testing Procedures: In-vitro methods like blood testing measure the antibodies released into your blood when your body comes in contact with specific allergens. Medicare covers in-vitro testing if your physician determines that skin testing is impossible or unreliable, or if they believe in vitro testing is medically necessary.
- Food Challenge Testing: A food challenge test looks for a response to ingesting a food allergen sample to help pinpoint exactly which foods trigger an allergic reaction. Medicare covers these types of tests when they’re done on an outpatient basis.
Coverage Limitations
The following tests are considered not medically necessary and are generally not covered by Original Medicare:
- Ingestion food testing performed by the patient at home and not in the office setting
- Provocative testing for which there is limited or no evidence of validity and has not been evaluated for efficacy
- Experimental and investigational tests like IgG and IgG Subclass Antibody Tests
- Radioallergosorbent tests (RAST), fluoroallergosorbent tests (FAST), and multiple antigen simultaneous tests (MAST)
- ELISA (enzyme-linked immunosorbent assay) tests
- Quantitative multi-allergen screening
- Cytotoxic leukocyte tests
- Sublingual and subcutaneous provocative and neutralization testing and neutralization therapy for food allergies
How Does Medicare Advantage Cover Allergy Testing?
Medicare Advantage Plans are offered by private Medicare-approved insurance companies and must cover, at a minimum, everything that Original Medicare (Parts A and B) covers. And since Medicare Part B provides coverage for allergy testing, MA plans must also cover it.
Medicare Advantage Plans often offer coverage for healthcare services that Original Medicare does not cover, such as prescription drugs, dental care, and additional allergy tests. Remember, though, that each MA plan is different, so be sure to review the specifics of your plan to understand the policy details around allergy testing.
How Much Does Allergy Testing Cost With Medicare?
The cost of allergy testing varies depending on the type of test you’re getting. Skin tests without Medicare coverage will typically cost you between $60 to $300, and a blood test for allergies can range from $200 to $1,000.
If you’re enrolled in Medicare Part B, you’ll only be responsible for paying 20% of the cost, assuming you’ve already met the deductible amount of $226 for the year and paid your standard monthly premium, which is $164.90 in 2023.
Because allergy tests, especially blood tests, can be expensive without insurance, always verify that Medicare will cover the testing before agreeing to it.
Medicare Advantage Costs
The costs of allergy tests may vary depending on your specific Medicare Advantage Plan’s cost-sharing structure and coverage amount. If your MA plan covers the allergy test, your insurer will most likely shoulder most of the costs, but you still may be responsible for a copayment amount and yearly deductible.
Does Medicare Cover At-Home Allergy Tests?
At-home allergy tests are growing in popularity due to their convenience. They generally involve pricking your finger to get a blood sample, mailing it to a lab, and receiving your results later through email or text.
However, neither Original Medicare nor Medicare Advantage Plans typically cover at-home allergy tests. If you think you may have allergies, schedule an appointment with your primary physician, who can order and conduct an allergy test that Medicare may cover.
Putting It All Together
Allergies affect more than 100 million people in the United States. If you’re enrolled in Medicare and are among the many who suffer from allergy symptoms, contact your physician to see if they could provide you with an allergy test that Medicare covers. And if Original Medicare does not help pay for the specific allergy test you need, explore Medicare Advantage Plans that often offer additional allergy testing benefits and may even cover prescription medication to ease your symptoms.