Does Medicare Cover Allergy Shots?

Allergic Rhinitis is pretty common nowadays, affecting millions of people. These severe allergies can be annoying and uncomfortable. And one of the best ways to treat them is through allergy shots.

For those over 65, a common question many have is, “does Medicare cover allergy shots?” In this article, we answer this question in clear, plain English. You will also find the average costs of allergy shots, as well as other helpful info.

Does Medicare Cover Allergy Shots?

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.

For Medicare to provide coverage for your allergy shots, you will need your doctor to say the shots are medically necessary. You’ll need a prescription from them that says you need the allergy shots because other treatments were not sufficient and your symptoms have become severe.

Coverage will fall under Medicare Part B. If the requirements are met, then Medicare will pay 80% of the costs for your allergy shots. Because these shots are given at a doctor’s office, each visit may have separate copays.

Medicare Advantage or Medicare Part C may also cover allergy shots as they are required to cover at least as much as Original Medicare plus additional plans.

How Much Do Allergy Shots Cost?

Without insurance, allergy shots can cost between $1,000 and $4,000 per year. For those just starting their course of treatment, the costs may be even higher. Once in the maintenance phase, you’ll typically get 1-2 shots per month for 3 to 5 years. This will cause the costs of your allergy shots to drop.

What Are Allergy Shots?

Many people mistakenly think of Allergic Rhinitis as a disease. However, it is not. It’s just our body’s reaction to allergens which are harmless substances.

For some, allergies are seasonal. For others, an exposure to specific allergens (ie. pet dander, mold) will cause the allergic reactions.

Allergy immunotherapy shots are effective because they make the body less sensitive to these allergen triggers. The way they work is by injecting small doses of allergens over time. Usually, they do not work immediately or for all types of allergies. This is why people take multiple shots for several years to experience long-term benefits.

Allergy shots may help improve severe symptoms brought by standard types of allergens such as pollen, grass, mold, dust mites, pet dander, and certain insects like bees and wasps.

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.