Does Medicare Cover Allergies?

Does Medicare Cover Allergies?

Allergies affect more than 50 million Americans every year, but reactions range from inconvenient sneezing or coughing fits to more severe, life-threatening events. While some people can manage occasional or seasonal allergies with over-the-counter drugs, many people face a more consistent need for treatment from a medical professional. According to the Centers for Disease Control and Prevention (CDC), allergies are the 6th leading cause of chronic illness in the United States, and seniors can be especially vulnerable to serious complications. If you are 65 years of age or older, or under 65 with certain disabilities, and are enrolled in Medicare, your insurance can help you get the allergy care you need at a price you can afford.

What are Allergies?

Allergies are an overreaction of the immune system, and while allergies cannot be prevented, they can be controlled by medication and immunotherapy when avoidance is not an option.

Types of Allergies

There are many types of allergies that can affect your daily activities and overall health. The most common allergic diseases include:

  • Asthma
  • Hives
  • Hay fever
  • Conjunctivitis
  • Eczema
  • Dermatitis
  • Sinusitis

Food allergies, although more common in children, can exist at any age, and can cause chronic gastrointestinal issues. Other allergies include reactions to latex, insect stings from hornets, wasps, bees, or fire ants, and over-the-counter or prescription medications. Some allergic reactions, such as those associated with hay fever – sneezing, an itchy throat, red eyes, a stuffy or runny nose – are more easily managed than more serious reactions, like anaphylaxis.

Anaphylaxis is the most severe allergic reaction and needs to be addressed immediately. The symptoms of anaphylaxis can include:

  • Light-headedness or dizziness
  • Tingling of the palms of the hands, soles of the feet or lips
  • Tightness of the chest
  • Trouble breathing
  • Vomiting
  • Diarrhea
  • Rapid heart beat
  • Abdominal pain

If you experience any of these issues, please call your physician immediately.

How Can Medicare Help?

If you have chronic allergies or experience a more serious allergic event, your Medicare coverage can help you get the help you need to diagnose and treat your illness. Medicare Part B (Medical Insurance) will cover services or supplies that are needed to diagnose or treat your medical condition as long as they meet accepted standards of medical practice. Your physician may order tests to diagnose the allergy, including skin tests (referred to as scratch or puncture tests) or blood work, and can prescribe medications, shots, or nebulizers to treat the allergies.

If you have Original Medicare, you will likely pay 20% of the Medicare approved amount, as long as your physician accepts assignment, and your Part B deductible applies. A Medicare Supplement policy, also known as Medigap, may help pay some of the out-of-pocket expenses Original Medicare does not, such as deductibles, coinsurance and copayments. Unfortunately, Original Medicare and Medigap policies will not help cover the cost of prescription drugs. Enrolling in a stand-alone Prescription Drug Plan (PDP) can help you pay for any medications prescribed by your doctor to treat your allergy.  If you are comparing PDPs and currently take allergy medications, check each plan’s formulary before enrolling to make sure that your specific medication and dosage will be covered by the plan you are considering.

If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same benefits as Original Medicare, but many MA plan offer additional benefits, including prescription drug coverage that may help pay for allergy medications. MA plan costs and benefits can vary, and each plan will have a unique formulary, or list of covered drugs.