Coffee & Coverage: Allergy Testing

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Did you know that more than 50 million Americans are affected by allergies? From hay fever to food intolerances to eczema, allergies can attack from all sides. They are the sixth leading cause of chronic illness in the country, and every day hundreds of people are newly diagnosed through allergy testing.

If you suspect that you have an allergy, and your physician prescribes testing, it is vital to know whether you are covered through your Medicare benefits plan. Here is what you need to know about your Medicare coverage.

6 most common types of allergies:

  • Stinging insect allergies
  • Latex allergy
  • Medication allergies
  • Food allergies
  • Skin allergies
  • Nasal allergies

Tests

To understand a person’s symptoms, a person’s doctor will ask questions about their medical history, and may also do a physical examination. Other tests may check how well a person’s lungs function and the doctor may ask for an X-ray.

Under Medicare Part B medical insurance, Medicare recipients will have coverage for clinical diagnostic laboratory tests if their doctor has prescribed them to diagnose or rule out a suspected allergic disease. Some examples of the allergy testing procedures are:

  • Percutaneous (skin) procedures test your reaction to substances such as inhalants (pollen, or animal dander for example), food, insect stings, certain drugs, or other agents. In percutaneous procedures, the skin is marked with a graph. Then, the skin is pricked or scratched, and the different suspected allergens are applied and recorded.
  • Blood testing procedures for allergens measure the antibodies in the blood that are released when your body comes in contact with specific allergens.
  • Food challenge testing is covered by Medicare when the testing is done on an outpatient basis. For this type of testing, patients consume increasing amounts of the suspected food until there is either a reaction, or the doctor can rule out an allergy.

Not all allergy testing procedures are paid for by Medicare, so it is important to know which test types are covered. You should consult your physician before testing to ensure that your Medicare benefits plan will pay for your specific procedure.

Costs

After your deductible is met, you generally pay 20% of the Medicare-approved amount for doctor services, outpatient therapy, and durable medical equipment (DME). You may also owe a copayment for certain outpatient services. Following are the details of costs for certain Part B services. The standard Part B premium in 2021 is $148.50, but may alter based on the person’s annual income. Part B deductible and coinsurance is $203. Part C and D premiums may vary among different plans. 

A person can ask their doctor for the test costs, and if the recommended test is covered by Medicare. In addition, if a person has coverage through Medicare Advantage or Part D, then the plan premiums, deductibles, coinsurance, and copays will affect cost. A person can use this online tool to check the costs of various plans.

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Treatments

Allergy treatments may include allergy shots, medicine, and avoiding the substance that causes the allergic reaction. A person’s doctor may also suggest a plan to manage or prevent a recurrence of the allergies. 

Other recommendations may include:

  • taking medicines as prescribed
  • keeping a diary to keep track of possible allergens
  • getting a prescription for an epinephrine auto-injector, to be prepared for a severe allergic reaction
  • wearing a medical alert bracelet

Note: If a person’s allergy symptoms are considered mild, they may be treated with over-the-counter medicine.

Allergy Medications

According to the American Academy of Allergy, Asthma,& Immunology, allergies such as allergic rhinitis (hay fever), allergic conjunctivitis (eye allergy) and urticaria (hives) are common problems for seniors and often require the use of antihistamines. 

Antihistamines are divided into two classes that can cause different side effects:

  1. First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common if you are being treated with certain antidepressant medications.
  2. The second and third generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Physician and allergist prescribed antihistamines currently in use are generally second or third generation drugs that have an extremely favorable safety profile for users.
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