What's New in Allergy and Asthma?

How Does Medicare Cover Allergies?

How Does Medicare Cover Allergies?

Do you suffer from allergies? The American College of Allergy, Asthma, and Immunology lists allergies as the 6th leading cause of chronic illness in the United States. Each year over 50 million people in the U.S. alone suffer from allergies.

Considering the vast number of people who suffer from allergies, it is important to discuss how Medicare covers various treatment options.

What is Medicare?

Medicare is a federal insurance program in the United States for people 65 and older and/or with disabilities or end-stage renal disease. The Medicare program is divided into different parts of coverage. As a Medicare beneficiary it is important to know the different parts of Medicare.

Part A

Medicare Part A will cover your inpatient stay at the hospital, skilled nursing facility, or hospice center. It is best to think of this part of Medicare as your hospital insurance.

Part B

Medicare Part B will cover your outpatient doctor services as well as other medical care. Medical supplies, durable medical equipment (DME)  and preventative services would fall under Part B.

Part C

Medicare Part C is often referred to as Medicare’s “all in one” plan called Medicare Advantage. These plans are regulated by Medicare but offered by private insurance companies.

Part D

Medicare Part D plans are also offered through private insurance companies and provide coverage for prescription drugs.

Medigap

Medicare Supplement plans, also referred to as Medigap,  are private plans.  These plans cover some of your out-of-pocket costs under Part A and Part B.

Medicare Coverage for Allergy Testing and Immunotherapy

Allergies can range in severity, but for many people, immunotherapy treatment is needed to help the body build up an immunity to a specific allergen.

Allergy Testing

In order to determine whether you have an allergic reaction to a particular substance, an allergy test is needed. Medicare will generally cover two types of allergy tests:

  1. Percutaneous Testing – also referred to as a scratch test. When using this method of testing, different allergens are put as trace amounts in a solution. The medical professional administering the test will use a lancet to prick your skin allowing the trace amount to make contact. If you are allergic, a small red bump will appear.
  1. Intradermal Testing – this type of testing is slightly more invasive than percutaneous testing. A small thin needle is injected just below the surface of the skin and the diluted allergen is injected.

Typically, your allergist will opt for the less invasive percutaneous test before deciding to do an intradermal test.

The outpatient coverage from Medicare Part B would cover this type of medically necessary allergy testing. After meeting your annual Part B deductible ($185 in 2019), you would be responsible for 20% of the remaining costs. Alternatively, if you have a Medigap plan such as a Plan G or Plan F, you may not pay any out-of-pocket costs for your allergy testing.

Immunotherapy

Immunotherapy is another word for allergy shots. This type of treatment is one of the most effective ways to treat allergies.

When it comes to coverage, if your doctor has prescribed this type of allergy treatment, Medicare will cover 80% of the allowable charges for necessary immunotherapy to treat your symptoms.

Medicare Coverage for Asthma

Asthma is a condition often associated with chronic allergies. Asthma makes breathing difficult as it causes the airways to swell, sometimes severely. Asthma attacks can be caused by certain allergens. Often, doctors will work out an asthma plan for patients at risk for asthma attacks that include an inhaler. Quick-acting rescue inhalers can help immediately expand airways.

Typically, inhalers or other fast-acting medications for asthma will be covered under a Medicare Part D plan. It is important to look over the plan’s formulary and coordinate with your doctor to prescribe a medication listed on your formulary.

Furthermore, Medicare Part B will cover durable medical equipment (DME) such as nebulizers and oxygen equipment. It is important to make sure your doctor and DME supplier accept Medicare.

In all, the treatment of your allergy and asthma symptoms will generally be covered by Medicare if the treatments are medically necessary and prescribed by your doctor.

– by Danielle Kunkle

Leave a Reply

Your email address will not be published. Required fields are marked *