Does Medicare Cover Allergy Shots? 

If you’re bothered with allergies that aren’t getting better with medication or other treatments, your physician might suggest that you try treatments with allergy shots.

Allergy shots, which are given over regular periods for three to five years, are a type of immunotherapy. These injections introduce a small amount of the specific allergens that are causing your allergic reactions. The amount of the substance injected is slowly increased, so your immune system can build up a tolerance to the allergens. 

Allergy shot treatments are typically prescribed for people who experience seasonal allergies, problems with inside allergens like dust, etc., or allergic reactions to insect bites. They are used for food allergies or chronic hives. 

You might be a good candidate for treatments with allergy shots if:

• You find it difficult to avoid allergens that trigger reactions and medication doesn’t help.
• Allergy medications cause side effects, or you can’t take them with other medications you’re on.
• You want to stop taking allergy medications
• You have a severe allergy to insect stings 

If your health care provider thinks allergy shot treatments would help you, Medicare may cover some of the expenses.

Does Medicare cover allergy shots? 

Allergy shots are usually a result of results from allergy testing. Original Medicare Part B(medical insurance) may cover your treatment with allergy shots, but this depends on the type of allergy you have. To determine the type, you must first be tested. Medicare Part B will cover your allergy testing under the clinical diagnostic laboratory services benefit if you meet all the following criteria:

• Your physician, who accepts Medicare assignment, prescribes your allergy tests. 
• The prescribing physician certifies, in writing, that the tests are medically necessary
• Your testing is done in a laboratory that accepts Medicare assignment
• Other types of allergy treatments have been unsuccessful in treating your allergies or their symptoms. 
• The prescribing physician provides proof that the allergy testing is the initial part of a complete, Medicare-approved treatment plan. 

Medicare Part B covers the following types of clinical diagnostic laboratory tests for allergies:

• Percutaneous procedures
• Blood tests
• Food challenge tests

Medicare Part B pays 100 percent of the cost for covered allergy tests, but because not all allergy tests are covered by Medicare, you should ask your physician about your specific tests before you have them done.

If you are enrolled in a Medicare Advantage (MA)plan, your provider must cover the same benefits as those included in Original Medicare Parts A and B. Depending on the type of MA plan you have, you may need to use physicians and laboratories that are in your plan’s network of approved providers to be eligible for coverage. Your plan may also charge a copayment for your tests. 

Allergy shots

When your health care provider determines the type of allergy you have, and whether it is treatable with allergy shots, Medicare Part B may cover the treatments if the following is true:

• A health care provider who accepts Medicare assignment prescribes allergy shots. 
• The prescribing physician certifies that the allergy shots are medically necessary to treat your condition. 

Original Medicare Part B pays 80 percent of the final, Medicare-approved cost for allergy shots when they are done in a medical facility that accepts Medicare assignment. You pay 20 percent of the cost after paying your Part B deductible. 

Medicare Advantage covers allergy shots when you meet Medicare qualification requirements, but you may need to use in-network providers for your care. The amount of your coinsurance charge depends on your MA plan. 

How much do allergy shots cost without Medicare insurance? 

Without Medicare coverage, you will have to pay for the allergy serum and the administration of the allergy shot, and costs vary around the country. The national average cost of allergen serum for one application is approximately $100, and around $20 to $100 per visit for the administration. In most instances, allergy shots are given once a week, which means you might pay between $1,000 and $4,000 annually.