How Medicare Can Help With Allergies
Key Takeaways
- Medicare coverage can help you get allergy testing and treatment.
- Original Medicare covers diagnostic testing and allergy shots when prescribed for certain symptoms.
- To get coverage for most prescription drugs, such as antihistamines or corticosteroids, you need a Medicare Part D plan or a Medicare Advantage plan that includes Part D coverage.
If you feel like the allergy season has been getting more severe and lasting longer over the years, you’re not alone. Experts like Dr. Kari Nadeau, the chair of the Department of Environmental Health at the Harvard T.H. Chan School of Public Health, say that warmer weather conditions and carbon dioxide in the atmosphere have affected plants in ways that can affect seasonal allergies.
“Trees are getting the wrong message and they’re releasing pollen earlier in the season,” she explained to Boston 25 News.
With allergies becoming worse for many people, it’s a good time to make sure you’ll have the health coverage you need to manage any symptoms for years to come. Through Medicare, the health insurance program for U.S. adults who are over 65 or have certain disabilities, you may be able to access a range of services to detect and treat allergies.
Living With Allergies
Allergic reactions happen when your immune system responds to a foreign substance in the air, foods, clothing materials, or drugs. Allergies commonly give you symptoms like a runny nose, cough, sneezing, itchy eyes, or a rash. In certain cases, like allergies to peanuts or bee stings, there’s the potential for more serious issues, including anaphylaxis, a reaction that sends the body into shock and can lead to death without treatment.
According to 2021 data gathered by the Centers for Disease Control and Prevention (CDC), nearly a third of U.S. adults have at least one allergy. The most common type is seasonal allergies, followed by eczema (which often causes dry, itchy skin), and then food allergies.
People with any of these conditions should avoid their triggers whenever possible, but medication can help to manage symptoms. Some of the most common treatments for allergies include:
- Allergy shots: Also referred to as immunotherapy, this form of treatment lowers a patient’s sensitivity and reduces symptoms by gradually exposing them to limited amounts of an allergen.
- Antihistamines: These drugs block histamines, the chemicals produced by your immune system that otherwise cause symptoms like sneezing, runny nose, and nasal congestion.
- Corticosteroids: These anti-inflammatory medications may come as nasal sprays, creams, ointments, pills, or liquids.
- Decongestants: Administered as nasal sprays, pills, drops, liquids, or powders, these drugs provide temporary relief for nasal congestion.
- Epinephrine: Also called adrenaline, these injections are used in emergencies to treat severe allergic reactions from foods, drugs, bites, or stings.
Allergy sufferers can get relief from decongestants, antihistamines, nasal sprays, and eyedrops that are available over the counter. However, you may need a professional diagnosis and a prescription to buy certain drugs or for stronger formulations to treat serious allergic conditions.
Medicare Coverage for Allergy Tests
Testing to confirm you have an allergy may be covered by Medicare Part B. This is the part of Original Medicare that provides medical insurance for outpatient services, including diagnostic lab tests. According to guidelines from the Centers for Medicare and Medicaid Services (CMS), your healthcare provider must recommend the test as medically necessary to have it covered.
Testing can also be covered by Medicare Advantage plans (often called Medicare Part C), which are offered by private insurers to substitute for Original Medicare. These plans are required to match Original Medicare’s coverage, and they often include a variety of supplemental benefits. Depending on your plan, you may be able to access different or additional tests.
If you show signs of an allergic reaction, your doctor might order one of these tests:
- Skin test: Technically referred to as a percutaneous test, in this procedure a healthcare provider exposes your skin to potential allergens, looking for a reaction. These tests can be used to diagnose many conditions like eczema, hay fever, and allergies to foods, penicillin, and bee stings.
- Blood test: Some people can’t take a percutaneous test because they have skin conditions, are taking certain medications, or are at risk of a severe allergic reaction. In cases like these, a healthcare provider may administer a blood test to check for antibodies that the immune system tends to produce in bigger quantities when you’re exposed to allergens.
- Oral food challenge test: To check for a food allergy, a healthcare provider can supervise you eating small amounts of the suspected allergen. As you gradually consume more, the provider watches for any indications of an allergic reaction. If you eat a full dose without reacting, that food is ruled out as a cause of your allergies.
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Does Medicare Cover Allergy Shots and Other Treatments?
CMS guidelines state that allergy shots can be covered by Medicare Part B when prescribed to treat nasal or eye symptoms, allergic asthma, or allergies to stinging insects. To get coverage for most other prescription medications, though, people on Original Medicare need a Medicare Part D prescription drug plan.
You can enroll in a Medicare Part D plan from a private insurer. Each plan has its own monthly premium, deductible (the amount you must pay before your coverage kicks in), and copays (the portion of a drug’s cost you’re responsible for paying). If you’re considering a Part D plan and know you will need a certain prescription allergy medication, you should check that it’s on the formulary (the list of covered drugs) and find out how much a regular supply will cost.
As an alternative, you may choose to enroll in a Medicare Advantage plan, which matches the coverage for immunotherapy provided by Original Medicare and in most cases includes Part D coverage. Depending on your health and financial situation as well as what options are available in your area, you may be able to enroll in a plan with supplemental benefits that help with the costs of over-the-counter items. That could make it more affordable to purchase non-prescription treatments to manage your symptoms.
An allergy often makes simple things like watching the seasons change or going out for a meal way more complicated. Fortunately, Medicare provides support to get an allergy diagnosed and treated. By understanding and managing your allergies, you can enjoy a fuller, healthier life.
Sources
Allergy Immunotherapy. CMS.gov.
Global warming causing earlier, more intense allergy seasons. Boston 25 News.
Allergy Facts and Figures. AAFA.
More Than a Quarter of U.S. Adults and Children Have at Least One Allergy. NCHS.