Spring is in full bloom, and for many of us, that means allergy season is here too. Sneezing, itchy eyes, and runny noses are all too familiar this time of year, especially with pollen counts on the rise. If you’re a Medicare beneficiary, you might be wondering: What does Medicare cover when it comes to allergy testing, treatments, and those pricey prescriptions? Good news—you’ve got options! Let’s break down how Medicare can help you breathe easier this season.
Medicare Part B Coverage and Allergy Testing
Allergies can range from mildly annoying to downright debilitating, and figuring out what’s triggering your symptoms often starts with testing. Medicare can step in to help, but there are some key details to know.
If you’re enrolled in Original Medicare, Part B (medical insurance) covers allergy testing when it’s deemed medically necessary. This means your doctor must order the test, and it should be part of a broader treatment plan.
Covered tests include:
- Percutaneous (skin) tests: These involve pricking or scratching your skin with tiny amounts of allergens—like pollen, pet dander, or certain foods—to see if you react. Think of it as a quick way to pinpoint what’s setting off your sneezes.
- Intradermal tests: A deeper skin test where allergens are injected just under the surface, often used if skin pricks don’t give clear answers.
- Blood tests: These measure antibodies (like IgE) in your blood to identify allergens. They’re handy if skin tests aren’t an option due to skin conditions or medications.
- Food challenge tests: Done outpatient, these involve consuming small amounts of a suspected food allergen under medical supervision. Medicare covers this if it’s necessary to confirm a diagnosis.
But Here’s The Catch….Medicare only covers tests proven to deliver accurate results, backed by science. Your doctor needs to document why the test is needed—say, if over-the-counter meds aren’t cutting it—and the testing must happen at a Medicare-approved facility.
What are the costs?…Once you’ve met your Part B deductible ($257 in 2025), Medicare pays 80% of the approved amount, and you’re responsible for the remaining 20%. For example, if a skin test costs $100, you’d pay $20 out of pocket after the deductible. Not too bad, right?
- Medicare Advantage (Part C): If you’re on a Medicare Advantage plan, you’re covered for at least the same tests as Original Medicare, since Part C plans must match Part A and B benefits. Some plans might even offer extra allergy-related perks, but costs like copays or coinsurance vary—let’s check with your provider!
Allergy Treatments: Shots and Beyond
Once you know what’s triggering your allergies, treatment is the next step. Here’s how Medicare helps:
- Allergy Shots (Immunotherapy): These injections gradually desensitize you to allergens, and Medicare Part B covers them if your doctor says they’re medically necessary. Coverage continues as long as you show clinical improvement—typically assessed after a couple of years. Part B pays 80% after your deductible, leaving you with 20% (unless you’ve got supplemental coverage like Medigap). * Note: Sublingual immunotherapy (under-the-tongue tablets) isn’t covered, as evidence on its effectiveness is still uncertain.
- Outpatient Advantage: Since shots are given at a doctor’s office, they fall under Part B, not Part D. Costs can add up—Healthline cites studies showing claims ranging from $748 to $849 annually—but Medicare’s 80% coverage softens the blow.
Prescription Costs: What’s Covered?
Allergy meds can be a lifeline, but those costs can sting. Here’s where Medicare Part D (prescription drug coverage) comes in:
- Covered Meds: Part D plans, available as standalone plans or bundled with Medicare Advantage, cover self-administered allergy drugs like:
- Antihistamines (e.g., Claritin, Zyrtec—prescription versions)
- Nasal corticosteroids (e.g., Flonase, if prescribed)
- Epinephrine auto-injectors (e.g., EpiPens) for severe reactions
- The Fine Print: Coverage depends on your plan’s formulary (drug list). Call our office to go over your plans formulary list, or, you can log into Medicare.gov’s Plan Finder tool, plug in your meds, and see what’s covered. Costs vary—premiums, copays, and deductibles differ by plan—but Part D can save you big compared to paying out of pocket. For instance, an EpiPen might cost $600+ without insurance, but with Part D, you might pay a $20-$50 copay.
- OTC Meds: Over-the-counter drugs (like most Claritin or Flonase) aren’t covered by Part D, though some Medicare Advantage plans offer OTC allowances (e.g., a quarterly credit). Check your plan’s extras!
Ready to tackle those symptoms? Here’s how to make the most of your Medicare coverage:
Contact Our Office: Reach out to discuss your coverage and its full benefits, what’s covered in your Part D drug formularies, and Medicare-approved tests you may need to take advantage of, while confirming your out of pocket costs.
Talk to Your Doctor: Start with a visit to your primary care doc or an allergist who accepts Medicare. Describe your symptoms—persistent sneezing, wheezing, whatever’s bugging you—and ask if testing or shots are right for you. They’ll need to justify it as medically necessary.
Verify Providers: Ensure your doctor and testing lab are Medicare-approved to avoid surprise bills. You can confirm this on Medicare.gov’s “Find Care Providers” tool, or, simply call our office and we can assist you with verifying providers.
Ask About Extras: Some Advantage plans cover more—like OTC meds or specialist visits—so dig into your benefits summary.
Don’t let allergies win this spring! Allergy season isn’t just a nuisance; for over 50 million Americans, it’s a chronic challenge (per the CDC). Pollen might be Mother Nature’s glitter, but it’s no party when it’s clogging your sinuses! With Medicare, you’ve got powerful tools to fight back—whether it’s pinpointing triggers with a skin test or easing symptoms with a prescription. Beuttel Insurance is here to make sure you are equipped with the knowledge to take full advantage of your Medicare benefits this season. Get on our calendar here and schedule your coverage plan review today!
