How Does Medicare Cover Allergies?

Anyone who has allergies knows how finicky insurance companies can be when it comes to allergies. Heck, ANYONE who has insurance can understand how challenging it can be to get clear guidelines regarding what is covered and what is not. Having allergies and/or food allergies adds a new level to questions that you may have for your insurance agent. After all, being able to afford prescriptions that are life-saving and necessary are a huge part of the process. All of us can use some clarification to ease out minds and help us to feel a little less overwhelmed.

Today is National Insurance Day, what better way to share a guest article written by Danielle Kunkle. Danielle specializes in sharing content that helps people really understand Medicare (what it is, which part covers what, etc.). She is also on the Forbes Finance Council as their Medicare Expert. Danielle (and I'm sure, so many others) asks "There are a lot of questions surrounding allergies and Medicare such as what part covers what, does it cover medication, etc?" Let's find out what she has to share!

Whether seasonal or chronic, many Americans suffer from allergies. Allergic rhinitis affects over 50 million people in the country, according to the American College of Allergy, Asthma, and Immunology. If you get medical care for your allergies, here’s how Medicare covers allergy tests and treatment.

Allergy Testing and Immunotherapy

If you are significantly affected by your allergies, you may receive allergy shots as a form of treatment. First, though, you need allergy testing. There are two main types of allergy testing that Medicare may cover: These are puncture or scratch allergy tests, also known as per cutaneous allergy tests, and intradermal allergy tests.

• Percutaneous allergy tests check for allergies to foods, inhalants such as mold and dander, insects that bite or sting, and certain drugs like penicillin.
• Intradermal allergy tests check for allergies to inhalants, certain drugs, and insects that sting.

Usually, an allergist will recommend a percutaneous allergy test first. If the results are negative, the doctor may also perform an intradermal allergy test. These allergy tests are covered under Part B. Under Part B, you pay 20% of allowable charges after your deductible, which is $185 in 2019.

If you have positive allergy testing, your doctor may order allergy shots. Allergy shots are usually given by a medical professional in a clinical setting. Injections in a doctor’s office are generally covered under Part B.

Asthma and Durable Medicare Equipment

If someone has chronic allergies or is highly allergic to specific allergens, they could also have asthma. Asthma attacks are sometimes brought on by certain airborne allergens. If you are allergic enough to a certain allergen, it could trigger an asthma attack. People with severe asthma usually carry a rescue medication such as albuterol. Albuterol can come in the form of an inhaler and in a tube that can be used with a nebulizer. When medication is used in combination with durable medical equipment (DME) such as a nebulizer, then both the medication and DME are subject to Part B coverage.

For Medicare Part B to cover your DME, a doctor must prescribe it, it must be medically necessary, and you must order it from a Medicare-approved DME supplier. Part B covers DME at 80% of allowable charges. Medications for your nebulizer are also typically covered by Part B. When your asthma medication comes in the form or a pill, inhaler, or any other oral version, the medication will be subject to Part D coverage. While on a Part D plan, you will pay a monthly premium, as well as a copay or coinsurance for your medication. Check your plan’s formulary to be sure your medication is listed; if not, your doctor may prescribe an alternative drug.

Medigap Plan G

A Medigap plan pays after Original Medicare (Part A and Part B) and it helps cover the gaps you’re responsible for such as copays and coinsurance. Medigap Plan G covers covers nearly all your out-of-pocket expenses under Original Medicare, including the Part B copays and coinsurance, and any excess charges. Protection with Plan G means you won’t have to worry about paying for your allergy and asthma treatments. Instead, you can focus on staying healthy and enjoying your golden years.

A big thank you to Danielle for reaching out and offering this information to help our community and for what she does each and every day to help others! If you would like more information from Danielle directly, you can visit her on the web, Facebook, Twitter, Instagram and LinkedIn.