From hay fever to food intolerances to eczema, over 50 million people in the United States live with allergies. They are the sixth leading cause of chronic illness in the country, and every day hundreds of people are newly diagnosed through allergy testing.
If you suspect that you have an allergy, and your physician prescribes testing, it is vital to know whether you are covered through your Medicare benefits plan. The following details will give you the information you need.
Will Your Medicare Plan Coverage Help Pay for Allergy Testing?
There are two ways you can receive your Medicare benefits: Original Medicare and Medicare Advantage. Original Medicare includes Part A and/or Part B. Part A is hospital insurance and Part B is medical insurance. You can choose to get your Part A and Part B benefits through Medicare Advantage (Medicare Part C), offered through private companies that contract with Medicare to provide at least the same coverage as Original Medicare.
Because testing for allergies falls under the category of clinical diagnostic laboratory services, Medicare recipients who have Medicare Parts will have coverage. In order for Part B coverage to help pay for your allergy testing, you must meet the following criteria:
- The physician prescribing allergy testing must be enrolled in Medicare and accept assignment.
- All allergy testing must take place in laboratories that meet Medicare
- Your physician must provide documentation showing that this allergy
testing is medically necessary.
- Medicare recipient’s allergic history or symptoms have not
been managed by other, previous therapy alternatives.
- Your doctor can prove that the testing is the first step in a complete
treatment program. This program must also meet Medicare approval for
safety, effectivity and treatment duration.
Not all allergy testing procedures are paid for by Medicare, so it is important to know which test types are covered. You should consult your physician before testing to ensure that your Medicare benefits plan will pay for your specific procedure.
When should you see your physician for allergy testing?
Symptoms of an allergic reaction usually occur quickly after exposure. If you are experiencing symptoms, it is wise to make an appointment with your physician. They may refer you to an allergist who specializes in diagnosis and treatment of allergic diseases. Be sure that they accept Medicare assignment before doing testing. Some of the most common symptoms of allergic reactions are:
- Sneezing combined with itchy, runny nose or blocked nasal passages
- Eyes that are itchy, watering and red
- Wheezing and/or shortness of breath
- Dry, cracked skin, or red and irritated skin
- Persistent hives that are red, itchy
- Swollen lips, tongue, face or eyes
- In severe cases: swelling of mouth or throat which restricts breathing,
feeling lightheaded or fainting
What allergy testing procedures are covered by Medicare?
Under Medicare Part B medical insurance, Medicare recipients will have coverage for clinical diagnostic laboratory tests when the doctor or medical practitioner has prescribed them to diagnose or rule out a suspected allergic disease. Some examples of the allergy testing procedures are:
- Percutaneous (skin) procedures test your reaction to substances such as inhalants (pollen, or animal dander for example), food, insect stings, certain drugs, or other agents. In percutaneous procedures, the skin is marked with a graph. Then, the skin is pricked or scratched, and the different suspected allergens are applied and recorded.
- Blood testing procedures for allergens measure the antibodies in the blood that are released when your body comes in contact with specific allergens.
- Food challenge testing is covered by Medicare when the testing is done on an outpatient basis. For this type of testing, patients consume increasing amounts of the suspected food until there is either a reaction, or the doctor can rule out an allergy.
Allergic diseases are quite common in the United States. In many cases, symptoms are mild, and you can get relief from over-the-counter remedies. However, if you don’t feel better, or are still concerned, you should discuss allergy testing with your health care provider.