Does Medicare cover allergy testing and treatment?

Kimberly Lankford,

AARP

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En español

Published June 13, 2024

In this story

Third of adults • Allergy tests • Shots, immunotherapy • Medications • Cash vs. Medicare • Inhalers • Medicare Advantage • Keep in mind

Medicare covers testing, treatment and medications for most types of allergies, but coverage requirements and costs vary.

Allergy tests are typically covered under Part B, while medication falls under Part D. In a 2023 study of 2021 data, the Centers for Disease Control and Prevention reports nearly a third of adults 18 and older had a seasonal allergy, a skin allergy like eczema, or a food allergy.

Seasonal allergies were most common, affecting 25.7 percent of adults, followed by 7.3 percent of adults with eczema and 6.2 percent with a food allergy. Some people suffered from allergies in more than one category. Many adults continue to suffer from allergies as they get older.

Does Medicare cover allergy testing?

Medicare Part B covers most tests an allergist or primary care provider would order to detect allergic antibodies. Allergies are commonly detected through tests that expose skin to an allergen to prompt an allergic reaction.

Other tests include bloodwork or subject you to certain foods to test for allergic reactions. Regardless of how the test is administered, it must be considered medically necessary based on the patient’s medical history and physical exam to be covered.

“If somebody’s skin is not reactive, we do lab tests as well, but we always prefer skin tests,” says Elizabeth Johnson, cofounder of the National Association of Medication Access and Patient Advocacy.

Some tests must have prior authorization, requiring your doctor to explain why you need another test rather than a skin test, and the number of tests you receive could be capped. Medicare also won’t cover allergy tests considered experimental; the Centers for Medicare & Medicaid Services has a list of many experimental tests.

Medicare Part B pays 80 percent of the cost for covered allergy tests. You typically have a 20 percent copay, which you can pay with a Medigap plan or other supplemental policy.

Does Medicare cover allergy shots?

Medicare covers treatment such as allergy shots or allergy desensitization, also known as immunotherapy, which exposes your immune system to increasing doses of an allergen to create antibodies to block symptoms. People often get allergy shots if medication doesn’t control the symptoms or can’t be taken.

You can expect to pay 20 percent of immunotherapy costs under Part B unless you have a Medigap or other supplemental policy.

Does Medicare cover allergy medications?

While Part D covers allergy treatments, such as nose sprays and antihistamine pills that require a prescription, it generally does not cover nonprescription over-the-counter drugs.

But you can save money even on OTC meds, says J. Allen Meadows, M.D., a Birmingham, Alabama, allergist and executive director of advocacy and governmental affairs for the American College of Allergy, Asthma and Immunology.

Meadows explains: “The pills are incredibly inexpensive through wholesale retailers and Amazon. One of the national wholesalers I priced [was] generic Zyrtec, [which is] 400 tablets for $14, a year’s supply. With antihistamine pills and nose sprays, in many cases they’re not covered by insurance but even if they are, if the copays are much more than $1, for most people it’s much less expensive to buy them over the counter in wholesale clubs or on Amazon.

“I found Flonase for $25,” he says.

You can use the Medicare Plan Finder to see which Part D plans in your area cover prescription allergy medications and what you can expect to pay for them with each plan.

Is it worth paying cash vs. using Medicare’s insurance?

It’s always a good idea to compare the cost of paying directly with cash or using a discount card like Blink Health, GoodRx, Optum Perks, ScriptSave WellRx, SingleCare or other drug savings apps for a prescription rather than using insurance.

“In many cases, buying your prescriptions outside of your insurance with the GoodRx card is less expensive,” Meadows says, adding that you may need to change pharmacies. “I’ve seen tenfold differences in pricing of medicines an allergist prescribes — from $30 to $300 based on the pharmacy chain.”

The price for over-the-counter medications, both brand name and generic, can vary a lot by pharmacy. Many such as Allegra, Claritin, Flonase and Zyrtec are available at wholesale clubs and online retailers and can be less expensive than what you would pay at a local pharmacy. Even though you may find a coupon for over-the-counter drugs, you may need a prescription for the medicine to be eligible for the discount. GoodRx coupons are valid only with a prescription, even for OTC medications, and can only be used at the point of sale at a pharmacy or a pharmacy counter of a grocery store.

Antihistamine pills or topical treatments for skin allergies also vary in cost, but most allergists will work with you to find one that works within your budget or that Part D covers, even if that means switching to a different treatment. When choosing a Part D plan, be sure to compare coverage for all your medications, such as blood pressure and diabetes drugs, as well as your allergy meds.

Does Medicare cover asthma inhalers?

While asthma and allergies are considered two different types of conditions, allergic reactions can cause asthmatic symptoms that require asthma inhalers. Part D plans tend to cover powder-based inhalers over pump inhalers.

“The powdery ones are easier to use, and more companies cover them, but some people don’t like those powdery inhalers,” says Meadows, adding that fewer plans cover pump inhalers, which can be difficult to find for less than $200, even with a discount card. “If someone has asthma in addition to their allergies, they need to check the [Part D] coverage of their asthma inhaler during open enrollment each year.”

Johnson also suggests seeking financial help through the pharmaceutical company’s patient assistance program for inhaler coverage.

Does Medicare Advantage cover allergy tests and treatment?

Technically, yes, because by law private Medicare Advantage plans must cover at least the same services as original Medicare. But you can expect different copays. You may also have additional prior authorization requirements for allergy treatments.

Meanwhile, though MA programs’ prescription drug plans typically don’t cover over-the-counter medications, a growing number of Medicare Advantage plans provide some extra coverage for OTC drugs.

According to KFF, 85 percent of individual Medicare Advantage plans and 94 percent of special needs plans provide over-the-counter benefits in 2024. These benefits could come in the form of a credit, such as a $40 credit per quarter to buy OTC products that’s usually distributed through a flex card.

You can see if the plan covers over-the-counter drugs by searching plans in your area using the Medicare Plan Finder and looking at each plan’s “see more benefits” list in the right-hand column. You can get more details about coverage through the plan website under its summary of benefits.

Keep in mind

Even though Medicare Part D doesn’t cover many over-the-counter allergy medications, you can now withdraw money tax free from a flexible spending account or health savings account to cover these out-of-pocket costs, a change that took effect with the 2020 Coronavirus Aid, Relief and Economic Security (CARES) Act.

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Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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