While Medicare does cover allergy testing in specific cases, allergy shots are more of a gray area. Whether or not your shots will be covered depends largely on what sort of allergy they are designed to combat. It also depends on whether your doctor has prescribed shots and deemed them “medically necessary” for your particular condition. Allergy shot coverage will also depend on your particular Medicare plan. Part B plans usually feature allergy injection coverage or reimbursement. Some Part D plans do as well since they focus on various drugs and medications.
If you need financial assistance with allergy shots, it’s very important to consult with your doctor before receiving your shots, otherwise you may be liable for the full cost. If your doctor or the specialist administering the allergy shot is not enrolled in Medicare, you will not be covered and you will have to pay the full cost of the service.
Medicare’s official website offers little information about allergy shots, though it does mention various vaccinations and shots that fall under most Plan B coverage umbrellas. These include:
- flu shots
- hepatitis B shots
- pneumococcal shots
- tdap shots (tetanus, diphtheria, and pertussis)
Generally, Medicare Plan B patients will pay nothing for these shots as long as their doctor or qualified healthcare provider accepts the assignment. The “assignment” is an agreement between your doctor and Medicare that stipulates that your doctor is paid directly by Medicare, and that he or she accepts the payment that Medicare deems appropriate for the service. The assignment also mandates that your doctor or specialist will not bill you any more than the Medicare deductible and co-insurance payment.
Additional allergy medication
If you suffer from serious allergies or allergic reactions, your doctor may recommend medication in addition to allergy shots. Medicare Part D plans cover a wide range of medications. If your particular plan doesn’t cover the drugs you need, you should ask your doctor about generic brand medications as a substitute. In most instances, generic brands are as safe and as effective as more well-known brands, even though they are typically less expensive.
Depending on your allergies and your overall medical health, your doctor may recommend additional services or services more frequently than Medicare covers. In this case, you will be responsible for some or all of the additional cost, so be sure to ask your doctor specific questions relating to services and payment to ensure that you are covered. You may also call Medicare for more information by dialing 1-800-633-4227. If Medicare doesn’t meet your allergy shot needs, you may qualify for coverage under the Affordable Care Act (also known as Obamacare). Allergy shots are typically part of the allergy treatments covered by the ACA, so ask your doctor about whether or not you can take advantage of free preventative care.