Did you know that over 50 million people suffer from allergies annually here in the USA? While some people believe allergies to be a minor nuisance, they can be much more serious for some people. Considering the sheer number of people affected by allergies each year, they are actually considered to be a chronic illness.
Allergies come in many different forms too. There are skin allergies like eczema and food allergies like gluten sensitivity or an allergy to shellfish. Some people with allergies suffer asthma as well, which can be considerably more serious.
To diagnose allergies, doctors will often prescribe diagnostic exams or tests. If you are on Medicare, you’ll want to know how tests and treatments for allergies are covered, so let’s review Medicare’s outpatient and drug coverage for some common allergic conditions
Medicare Coverage for Eczema and Other Skin Allergies
Medicare provides coverage for a number of dermatology treatments for certain skin disorders. This may include psoriasis, dermatitis, shingles, rashes, and eczema. People with eczema suffer from skin that inflamed or itchy. The skin can feel dry and make by flakey. Usually, your Medicare doctor or dermatologist can diagnose eczema without testing and will often prescribe some lifestyle adaptations that you can make so that you have fewer eczema flares.
However, if your case is quite extensive, Medicare may cover more invasive treatments such as phototherapy. Dermatologists often prescribe phototherapy for adults with severe eczema. In this procedure, your doctor will expose your skin to UV light panels generated by a special machine. In the most common form of phototherapy, narrowband ultraviolet Blights are used which mimic the natural sunlight to treat eczema.
If other treatments have failed to produce positive results for your eczema, Medicare Part B may cover phototherapy. Part B is your outpatient coverage under Medicare so it will cover both your doctor visits regarding your skin condition and the procedure. In 2019, Medicare Part B has a deductible of $185. You will pay this deductible only once, and thereafter Medicare covers 80% of the costs of your Part B services. The other 20% is considered your cost-sharing, and you can expect to pay this yourself. Many beneficiaries enroll in Medigap coverage to help them pay for deductibles and coinsurance like this that Medicare does not pay.
There are also a number of medications which your doctor may prescribe to treat skin allergies. Outpatient medications are covered under Medicare Part D, which is voluntary prescription drug coverage that you can purchase to help reduce the costs of any prescription medications that you may need. Part D plans are offered by private insurance companies and each state may have two dozen or more plans to choose from. You can use Medicare’s website to search for the plan that offers you the best coverage for your specific medications.
Be sure to check the plan’s drug formulary to see the various types of allergy creams or oral medications available for your doctor to consider in your treatment.
Medicare Coverage of Various Food Allergies
Food allergies are also very common in America. Some of the more common allergens that can cause serious health reactions are peanuts, tree nuts, wheat, milk, soy, fish, eggs and crustacean shellfish. Some individuals are born with food allergies and learn about their allergy as a child. Other people develop certain food allergies slowly over time.
While food allergies could resolve on their own, more often than not they are something you will always be allergic to. Sometimes your doctor can perform skin tests or blood tests to confirm a food allergy and if documented as medically necessary by your doctor, Medicare Part B will cover these tests. Generally, Medicare will consider something medically necessary if there is a documented history of allergic reactions.
Another type of diagnostic test that Medicare may cover is a food challenge. In this test, the individual adds a certain percentage of a food type to their diet over a period of time. The percentage grows over time until a reaction occurs. Part B would also cover this test as it may be performed in a hospital outpatient setting.
If you are someone with severe food allergies or someone who is allergic to certain insects that sting, it may be necessary for you to carry an EpiPen for emergencies. This is an injectable dose of epinephrine that can counteract anaphylactic shock. Most Medicare Part D drug plans cover EpiPens. If you know that you need to carry an EpiPen, be sure that you confirm that your Part D drug plan includes your chose form of EpiPen in the plan’s drug formulary.
You can also check goodrx.com to see if any coupons are offered at your local pharmacy to reduce the cost of an EpiPen.