How Does Medicare Cover Allergies
If you are approaching age 65, you might be feeling some fear and trepidation over Medicare. After all, most of us have had our insurance selected for us by your employers during our working years. Now we must figure out a national health insurance program that has several working parts and lots of supplemental choices. It’s natural to be a bit uneasy.
Fortunately, once you understand how Medicare works, you’ll find that Medicare offers broad coverage at prices that are affordable for most retirees. The coverage is excellent as well, providing for medical treatment for any condition that doctors deem medically necessary. This includes treatment allergies, so if you suffer from allergies and have been concerned about how Medicare will cover your treatment, you can breathe a little easier – no pun intended.
Medicare is aware that allergies affect people of all ages. Indeed, a staggering number of Americans across all age spectrum are affected by allergies every year. According to the CDC, allergies affect more than 50 million Americans each year. Allergies are the 6th ranked cause of chronic illness in the US according to the American College of Allergy, Asthma and Immunology’s Asthma Facts.
When it comes to determining what’s covered, a general rule of thumb is that Medicare covers tests and treatments that are medically necessary and supported by evidence of effectiveness for the individual beneficiary. This includes allergy testing and some allergy treatment including food allergies, skin allergies, and asthma. The types of covered testing include percutaneous(scratching or puncturing skin) tests and intracutaneous(injecting allergen) tests.
Let’s look at how Medicare Parts B and D cover allergy treatments.
Medicare Part B
Medicare Part B provides for your outpatient medical coverage. Most allergy treatmentsare considered outpatient care, so they will fall under Part B. Your Part B coverage will pay 80 percent of the allowed costs of care after you pay your annual deductible, which is $183 in 2018. Part B will also cover some medications such as nebulizers that patients use on an outpatient basis.
A medical doctor that participates in Medicare must perform your allergy testing and treatmentfor it to be covered. Your doctor must show factors in your medical condition or medical history to support effectiveness and necessity of the tests and any ongoing treatment. Sometimes we have to be our own advocate when it comes to medical care, so don’t hesitate to ask your doctor whether a recommended treatment is typically covered by Medicare. You can also request that he or she notate medical necessity in your records.
Medicare Part D
Any allergy sufferer knows that medications are a big part of treatment and symptom control. This is why it’s surprising that for over forty years, Medicare had no outpatient drug coverage. We are lucky today that Medicare rolled out the Part D drug program in 2006. This program now providesfinancial assistance for the costs of prescription drugs.
While Medicare Part B pays for medically necessary treatment in the doctor’s office, modern medicine relies heavily on new and traditional prescription medications to manage allergies. Most of these are retail medications that you will pick up at the pharmacy yourself, so they will fall under Part D.
Medicare Part D can significantly lower your costs of prescriptions, and it can be particularly helpful for expensive brand name and upper tier medications. Since Original Medicare doesn’t cover outpatient medications, you can add a private standalone prescription insurance plan.
Selecting the right plan involves assessing the costs, deductibles and amount of coverage.We recommend that you use Medicare’ Plan Finder Tool at www.medicare.gov to assist you with this. You can enter your list of medications and preferred pharmacies This handy tool will help you determine which plans will cover the drugs that you need. It can also provide details about any restrictions a plan has on the specific amounts and medications that you use or will likely need.
Medicare covers tens of millions of people, and it has rules that the government intends to be helpful and overall beneficial. Coverage of allergies is no exception. Hopefully you are relieved to know that Medicare is good coverage when combined with the right supplemental coverage. Original Medicare combined with a Medigap policy will provide excellent medical care with predictable and manageable costs. This kind of peace of mind is important for everyone when facing retirement.
Consider meeting with a qualified Medicare insurance broker to discuss your needs so that you can find the options that best meet your needs, budget, and preferences.Danielle Kunkle is the co-founder of Boomer Benefits where she and her team help baby boomers navigate their entry into Medicare.