Does Medicare Cover Allergy Immunotherapy?

Allergies can develop at any point in our lives. There are many things that a person can be allergic to such as foods, insect stings and bites, foreign objects and irritants such as dust, pet fur, and even certain medications. But with allergy shots, we may find relief from the symptoms brought by our allergies.

If you suffer from allergies and are thinking about this type of treatment, you may be wondering “does Medicare cover allergy immunotherapy?” In this article, we answer that question in clear, plain English.

Does Medicare Cover Allergy Immunotherapy?

The short answer is yes. Medicare will cover the cost of allergy shots. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your allergy shots. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for allergy shots. Part B provides coverage for your allergy shots if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for allergy shots is provided by Medicare Part B. However, Medicare Part B does not necessarily have set guidelines with regards to coverage of allergy shots. That means that coverage decisions for allergy shots are made on a case-by-case basis by Medicare Part B.

However, to have a better shot (pun intended!) of having Medicare Part B’s coverage, we recommend that your healthcare provider prove that you need allergy shots to treat severe symptoms of your allergy. They should also let Medicare know that you have tried other types of treatment but none are effective. That way, your allergy shot administrations may be considered medically necessary.

Medicare Part B provides coverage for allergy shots as most of the time because the shots generally take place in an outpatient setting such as a doctor’s office. Once approved Medicare Part B covers 80 percent of the costs of your allergy shots. You will pay for the remaining 20 percent as coinsurance. You may have separate copays for each doctor’s visit.

Part C and Part D Coverage for Allergy Immunotherapy

Medicare Advantage plans (Medicare Part C) also provide coverage for allergy shots. These plans have to cover the same treatments and services that Original Medicare covers. These plans also offer additional benefits that Original Medicare does not cover. Exactly what each Part C plan covers and what your out-of-pocket costs will be depends on the plan you have.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.

Medicare Part D does not provide coverage for allergy shots as these are not medications that you take in your home. However, Medicare Part D plans provide coverage for medications that you need for your allergies.

How Much Do Allergy Shots Cost?

Administration of allergy shots usually costs $20 to $100 per visit. Often multiple shots are needed, which will increase the total cost.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.