Does Medicare Pay for Allergy Testing for Senior Citizens?
Medicare Benefits Solutions
Oct 11, 2022
Medicare may cover allergy testing and other diagnostic laboratory tests for seniors when certain criteria are met:
- The testing must be considered medically necessary
- You must have a note from your healthcare provider saying you need the test
- Your doctor must be enrolled in and accept the Medicare assignment
- Testing must be performed in a lab approved by Medicare
- Previous therapies have not been successful at managing allergy symptoms
- The testing is the first part of a comprehensive treatment program
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Is Allergy Testing Covered by Medicare?
Allergies can arise at any age. According to the American College of Allergy, Asthma & Immunology, over 50 million people in the U.S. have some type of allergy.
Seniors may be more susceptible to the onset of allergies due to changes in the immune system or the development of other conditions. You may notice that new seasonal allergies arise, especially if you travel or move to a different climate. Allergic reactions to food or medications can be common as well.
If you have a severe allergic reaction, call your medical provider or 911 in an emergency. If you start to notice mild to moderate allergies, but can’t place the source of the reaction, it may be time for you to see an allergist.
Allergy testing can help your doctor pinpoint the cause of your reaction so you can eliminate it or treat your allergy with medication. If you have Medicare, you may have help paying for the allergy testing under certain circumstances.
TIP: If you are looking for a Medicare Advantage plan that offers allergy testing and other labwork try our plan finder. Our handy tool can help you narrow down your options based on your needs and preferences – and help you find the plan that’s right for you.
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When is Allergy Testing Covered by Medicare?
Some prerequisites have to be satisfied before Medicare allergy testing is covered. Your doctor must collect your medical history and immunologic background, and a face-to-face physical exam is required. Medicare expects your doctor to use clinical judgment in determining the appropriate test in your particular case. Not everyone will be eligible for the same allergy tests.
Testing by scratch, puncturing, or pricking the skin, known as percutaneous testing, is the preferred method to check for hypersensitivity to inhalants, food, stinging insects and specific medications. If the results are negative, yet your doctor strongly suspects allergen sensitivity, intradermal tests may be performed. For contact dermatitis, Medicare considers the patch test to be the gold standard. You may undergo challenge ingestion testing for food allergies if appropriate. Medicare covers blood serum testing when the feasibility or reliability of the skin test is in question.
Your doctor must document the reason for the specific allergy test administered. Certain tests may require expanded justification and a case-by-case review for medical necessity. Medicare does not cover tests deemed as experimental since that means the tests have not been proven to be effective or appropriate.
TIP: Discover the top 7 reasons to switch your Medicare Advantage plan.
What Allergy Tests Does Medicare Cover?
The following are examples of common allergy tests and how healthcare providers use them:
Percutaneous skin prick test
This type of allergy test studies reactions to substances like insect bites, food and penicillin pricked or scratched into the skin.
Blood work can measure immunoglobulin E (IgE), antibodies in your blood produced by the immune system to release chemicals that invoke a reaction to specific particles.
Food challenge test
A challenge test looks for a response to ingestion of a small food allergen sample. This test typically requires an allergist to perform and supervise in case of anaphylaxis, which can be a life-threatening situation.
Intradermal (within or between layers of skin) test
An intradermal test checks your body’s response to airborne irritants, drugs and insect stings after injecting an allergen into your epidermis
A patch test analyzes your skin for a reaction to an allergen. A patch is applied to your skin fand left there for several days.
TIP: Check with your physician before scheduling an appointment as Medicare may not cover all types of allergy testing. Also, Medicare Part D may cover prescription allergy medications if you test positive for one or more allergies.
Top Allergy Symptoms
Your body’s response will vary with your specific allergy. Hay fever can cause headaches, itchy and watery eyes, shortness of breath and cold-like symptoms like nasal congestion, a runny nose and a sore throat.
Common allergy symptoms:
- itching, red or watery eyes
- runny or stuffy nose
- tingling mouth
- swelling of the face, throat, lips, or tongue
- anaphylactic shock
If you have these symptoms, you may need an allergy test.
When Do You Need an Allergy Test?
Allergists receive special training in testing, identifying, diagnosing and treating allergies.
Top food allergens:
- milk and other dairy products
- certain chemicals
- insect bites
- pollen from grasses, weeds, trees and flowers
- pet dander
Having an allergy means that your immune system is overreacting to specific types of substances.
Seniors and Allergies
If you develop specific intolerances, your doctor can guide you. For example, if you are lactose-intolerant, your doctor may suggest dairy-free alternatives or refer you to a nutritionist. People with asthma may benefit from testing that detects triggers compounding their symptoms.
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