Does Medicare Cover Food Allergy Testing?

While most food allergies develop during childhood, it is possible to develop them at any point in your life. So how can you learn if you are allergic to a certain food? The worst way is to have a reaction after eating a certain type of food. However, if you suspect you have a food allergy, there are tests that can help confirm whether you do or not.

If have concerns about food allergies, a common question you may have is, “does Medicare cover food allergy testing?” In this article, we answer that question in clear, plain English. There’s also information about the average costs for food allergy testing.

Does Medicare Cover Food Allergy Testing?

The short answer is yes. Medicare will cover the cost of food allergy tests. 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 food allergy tests. 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 food allergy tests. Medicare Parts A and B provide coverage for your food allergy tests if they are considered medically necessary. The tests must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for allergy tests is provided by Medicare Part B. For Medicare Part B to provide coverage for your allergy tests, your healthcare provider must:

Have a documented history regarding your allergic reactions
Show that you have significant symptoms that other therapies or treatments have not controlled

Medicare Part B only provides coverage for allergy tests that are proven to provide accurate and effective results for specific types of allergens. Most of the time, Medicare Part B provides coverage for percutaneous tests. A percutaneous test leads to reactions to suspected allergens such as:

Food
Inhalants
Insect stings or bites
Certain medications
Macromolecular agents

Medicare Part B also provides coverage for food allergy tests. During a food allergy test, a small amount of food is added to your diet in increasing amounts to see your body’s reaction.

Medicare Part B covers 80 percent of the costs of your food allergy test. You will pay for the remaining 20 percent as coinsurance.

Part C and Part D Coverage for Food Allergy Testing

Medicare Advantage plans (Medicare Part C) also provide coverage for food allergy tests. Advantage plans are required to cover the same treatments, tests and procedures that Original Medicare does. But this plans will also cover additional health services that Original Medicare does not. The specifics of what a plan covers and what the costs for the coverage is will vary from plan to plan.

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

Medicare Part D plans provide coverage for medications that you need for your allergies. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Food Allergy Testing Cost?

A consultation with an allergist usually costs between $150 to $300. An allergy test may cost anywhere from $60 to $1000 depending on the type of test.

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.