November 21st 2023
By Ari Parker
A guide to answer your questions about Medicare and allergy testing. Learn what kind of tests through Original Medicare and Medicare Advantage.
As bothersome as they are, allergies are incredibly common. Their symptoms can range from mild to life-threatening in some cases. If you need an allergy test, it’s important to know how your Medicare coverage works before getting tested.
Original Medicare does cover allergy testing when they’re considered medically necessary and are ordered by your doctor or provider. By law, Medicare Advantage plans must provide at least the same coverage as Original Medicare, but pricing structures vary. We explain the details of how coverage works for both Original Medicare and Medicare Advantage below.
Original Medicare Part B covers allergy testing if you meet certain criteria.
Medicare Advantage plans also cover the cost of allergy tests because they must cover legally the same services as Original Medicare.
Medicare Part D may handle some of the costs associated with a prescription for allergy medications.
When your body comes into contact with an allergen, a substance that your immune system finds threatening, it will release chemicals to try to protect you. This response can lead to symptoms such as sneezing, itching, watery eyes, and in severe cases, anaphylaxis.
It can be difficult to know exactly what substances cause your body to react in this way. Allergy testing helps diagnose which allergens are affecting you and create a tailored plan to mitigate future reactions.
The most common types of allergy testing include the following, and Medicare will cover the costs of these tests:
Skin Prick Test (SPT)
With a skin prick test, a medical professional will inject small amounts of common or suspected allergens into your skin with tiny needles to trigger an allergic reaction. They will then look for any reactions and diagnose and treat accordingly.
Blood Tests (e.g., RAST or ImmunoCAP)
With blood tests, a medical professional will analyze your blood sample for the presence of specific antibodies released as a result of an allergen. The results of the blood sample will determine diagnosis and treatment for your allergy.
Food Test
For food allergy testing, you would eat a certain amount of a food you think is causing your allergy. You would eat until there was a reaction or the doctor could rule out the allergy. Medicare covers the cost of food tests when they are done in an outpatient setting.
If you experience any of the following symptoms suddenly or on a recurring basis, you should get in touch with your physician to test for allergies. Make sure that your doctor accepts your Medicare plan before scheduling an appointment or receiving services.
Sneezing combined with itchy, runny nose or blocked nasal passages
Eyes that are itchy, watering and red
Wheezing and/or shortness of breath
Coughing
Dry, cracked skin, or red and irritated skin
Persistent hives that are red, itchy
Swollen lips, tongue, face or eyes
In severe cases: swelling of mouth or throat which restricts breathing, feeling lightheaded or fainting
The average cost of an allergy test without insurance will depend on a variety of factors like location, health facility, and the type of test you take. You could pay between $0 to $500 for a skin prick test and up to $1000 for a blood test.
There are also at-home allergy tests you can use, but even these can be pricey without insurance coverage. With insurance, you can expect to pay $0-$50. Without insurance, you could pay up to $300 for an at-home allergy test.
Understanding your Medicare plan will help you navigate the costs of an allergy test. Both Original Medicare Part B and Medicare Advantage plans cover an allergy test.
If you have coverage through Original Medicare, Part B helps cover allergy testing because it falls under the category of a clinical diagnostic laboratory service. In most cases, you won't have to pay anything for these services if they are done at a Medicare-approved facility and your doctor orders the test. To get coverage through Part B, you will need to meet certain requirements:
Your doctor that prescribes the allergy test must take Medicare.
You must test in a lab that meets Medicare requirements.
Your doctor must provide proof that allergy testing is medically necessary.
Your history of allergies or symptoms haven’t been managed by other alternatives.
Your doctor believes that testing can result in a complete treatment program that Medicare approves of.
Medicare Part B could cover a skin prick test, blood test, or food test if a doctor or other medical professional advises it. In most cases, Part B will cover the total cost of a clinical laboratory test so you won’t have to pay anything. However, not all allergy procedures are covered by Medicare. It’s best to consult with your physician or check with your Medicare plan before taking an allergy test.
Medicare Advantage, also called Part C, is a bundled option for your coverage through private insurers that are Medicare-approved. Medicare Advantage is legally required to cover everything that Original Medicare (Part A and Part B) does. Because Part B covers allergy testing, Medicare Advantage plans should also help pay for these procedures.
However, cost structures vary from policy to policy. Talk to your provider or your insurance’s billing department to see what options you have for allergy testing with your Medicare Advantage plan.
If you have chronic issues with allergies or your symptoms are severe, you might need a recurring prescription filled. Medicare Part D could handle some of the costs associated with a prescription.
Original Medicare does not include insurance for prescriptions. That’s where Part D comes in. You can have a standalone Part D plan or bundle Part D within a Medicare Advantage plan. Part D as an addition to Original Medicare or bundled for Medicare Advantage could help pay for any necessary allergy medications. Check with your insurance for more details.
If you have more questions about what tests are and are not covered by Medicare plans, reach out to one of our licensed advisors who would be happy to assist you. Call us at (855)-900-2427.
