Does Medicare Cover Allergy Shots?
- January 12, 2024
- Reviewed by John Krahnert
More than a quarter of Americans have at least one allergy. While allergies can develop at any point, aging immune systems can make older adults more susceptible to allergic reactions and symptoms.
Original Medicare and some private Medicare plans cover allergy shots, depending on your circumstances. Learn more about how Medicare pays for allergy immunotherapy for qualified beneficiaries.
Will Medicare Pay for My Allergy Shots?
Yes, Medicare can pay for allergy shots, hut how those shots are covered depends on the Medicare coverage you have. Medicare is divided into four parts.
Original Medicare (Medicare Part A and Part B)
Original Medicare is comprised of Medicare Part A and Part B.
- Part A is unlikely to cover the cost of an allergy shot. Medicare Part A covers inpatient care administered in hospitals, skilled nursing facilities and other inpatient settings.
- Medicare Part B can cover allergy shots for immunotherapy if a doctor deems them to be medically necessary. Medicare Part B covers outpatient care received in doctor’s offices, rehab centers and other outpatient facilities.
If Medicare Part B covers your allergy shot, you will typically be responsible for a 20% coinsurance for the Medicare-approved amount if you’ve met your Part B annual deductible. In 2024, the Part B deductible is $240.
Medicare Advantage (Medicare Part C)
Medicare Advantage plans are required to cover everything covered by Medicare Part A and Part B. And that means Medicare Advantage plans will cover allergy shots for immunotherapy if they qualify for Part B coverage.
Medicare Advantage plans may use their own deductible, copayment or coinsurance amounts, so the cost you will pay for an allergy shot with a Medicare Advantage plan will vary from one plan to another.
In addition to covering all Original Medicare services and items, Medicare Advantage plans can provide benefits of their own that are not found in Medicare Part A or B.
Medicare Part D
Medicare Part D provides coverage for prescription medications that are acquired at a pharmacy for use in the home.
Because immunotherapy allergy shots are administered in a doctor’s office, they are not covered by Medicare Part D.
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance provides coverage for some of the out-of-pocket costs required by Medicare Part A and Part B.
These plans, also called Medigap, can cover the cost of coinsurance charged for an allergy shot by Medicare Part B. They can also cover excess charges, which is an additional coinsurance that may be charged by certain doctors according to the contract terms they have with Medicare.
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How Much Do Allergy Shots Cost With Medicare?
According to GoodRx, a vial of medicine used for a sublingual immunotherapy allergy shot can cost around $600 and should be expected to last one year. The number and frequency of injections needed will vary according to the type of allergy and allergy shot.
There are numerous types of allergies and many different types of medicine used in the shots, so the cost of allergy shots can vary widely.
Does Medicaid Cover Allergy Shots?
Most state Medicaid programs provide at least some coverage for allergy testing, shots and medications. Exact Medicaid benefits are determined by the state in which they are administered, so coverage will vary from state to state.
Check with your state Medicaid program to learn more about Medicaid allergy testing and treatment where you live.
Does Medicare Pay for Allergy Tests?
Allergy tests are included under the “clinical diagnostic laboratory services” category of Medicare Part B coverage and are covered when a doctor orders a medically necessary allergy test to be done.
Once again, the 20% coinsurance amount applies along with the annual Medicare Part B deductible. A Medicare Supplement Insurance plan can cover the cost of the Part B coinsurance charged for allergy testing.
Medicare Advantage plans also cover allergy testing and may have coinsurance and deductible amounts that differ from Medicare Part B.
Learn more by calling to speak with a licensed insurance agent. We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
