The American Academy of Allergy, Asthma & Immunology (AAAAI) estimates that more than 50 million people in the United States suffer from allergies annually. With Original Medicare, Part B covers allergy testing while Part D covers related prescription drug therapies. Medicare Advantage plans cover allergy testing as it includes Part B benefits. This can make a world of difference in the treatment you receive, as well as peace of mind. However, there are some requirements for coverage.
You should speak with your primary care physician about allergy testing if you:
- Have itchy, watery or red eyes
- Experience wheezing, coughing, or shortness of breath
- Constantly find yourself sneezing with an itchy, runny nose or blocked nasal passages
- Have skin that is dry, cracked, red and irritated
- Develop hives that are red, itchy and persistent
- Your lips, tongue, face or eyes swell
What Is Allergy Testing?
If you get hives, rashes, a stuffed nose or have trouble breathing, it may be due to an allergy. Once you set up an appointment, your doctor will ask questions about your medical history and likely perform a physical examination. They will then conduct skin allergy and blood tests in addition to tests to check how well the lungs function and utilize X-rays for diagnosis if needed.
Standard allergy testing includes:
- skin prick tests (SPT)
- intradermal skin tests
- patch tests
- blood tests (specific IgE)
- challenge tests (supervised by a doctor)
What Are The Different Types of Allergy Testing?
A skin test is one way to determine if you have an allergic reaction. It’s done by placing some of the suspected allergens on your arm and waiting for signs that it causes any hives, itching, etc. A blood test or an elimination diet may also help identify allergens in foods.
Other types of allergy testing include:
- Spirometry (Lung Function Tests)
- Food Challenges
- Medication (Drug) Challenge
- Aspirin Desensitization
- Patch Testing
While allergy test kits are available at pharmacies, these are not definitive and should never replace a physician’s examination.
How Much Do Allergy Tests Usually Cost?
The cost of allergy tests can vary depending on your insurance coverage. While Medicare covers laboratory tests, including specific blood tests and screening to detect cancer or diabetes, not all allergy tests are covered. Before committing to the allergy tests, discuss the out-of-pocket costs you will have to cover with your doctor.
How much you spend will vary based on various circumstances:
- What type of plan you have
- Insurance premiums, deductibles, coinsurance, and copays
- Doctor fees
- Doctor acceptance of assignment (Medicare-approved cost)
What Parts of Medicare Cover Allergy Testing?
Original Medicare Part B (medical insurance) and Medicare Part D (prescription drugs) offer allergy testing coverage and related services; however, not all types of testing are covered. Some allergy tests may be included in a Medicare Advantage plan that Medicare Part B doesn’t cover, but this varies by plan provider.
Medicare Part B
Medicare Part B may cover allergy testing if:
- Your physician has prescribed the test
- Your physician is enrolled in Medicare and has accepted the assignment (Medicare-approved cost)
- The test is deemed medically necessary, and your physician can provide the documentation
- The test takes place in a Medicare-approved laboratory
- Your allergies or symptoms were not resolved through previous therapy alternatives
- Your testing is part of a complete, Medicare-approved treatment program deemed necessary by your physician
Once you are approved, Medicare Part B will generally cover skin procedures, blood testing and food challenge testing.
Medicare Part D
Medicare Part D offers a comprehensive plan to help cover self-administered prescription drugs not covered by Original Medicare. It can be purchased through private insurance companies, and premiums depend on your particular policy listing details.
Medicare Part C (Advantage)
Medicare Advantage is private insurance offered by Medicare-approved companies. Some Medicare Advantage plans include additional benefits that Original Medicare does not, such as hearing, dental, and vision coverage. You can check whether or not your preferred Medicare plan covers allergy tests by contacting your insurer.
How to Get Medicare Coverage for Allergy Tests
Knowing how much an allergy test will cost before you undergo one can be challenging. Speak with your physician to ensure that the tests are covered by your Medicare plan and ask about any out-of-pocket costs, such as copays or deductibles.
If your current Medicare plan does not cover your tests needed, please don’t hesitate to call one of our specialists to discuss which plan would be better for you!