Medicare Part B covers allergy shots at a doctor's office, but you pay 20 percent of the cost after you meet your deductible
Yes, Medicare Part B covers allergy shots (immunotherapy) when a doctor prescribes them for allergic conditions. Medicare pays 80 percent of the approved amount for the injection itself and the office visit where you receive it. You are responsible for the remaining 20 percent, plus any amount above what Medicare considers reasonable for your area.
The coverage applies to shots given in a doctor's office, hospital outpatient department, or allergy clinic. Home-based allergy shots are not covered. You must have Part B active and meet your annual deductible before Medicare begins paying its share.
Key Takeaways
- Medicare Part B covers allergy shots administered in a medical office setting, paying 80 percent after your deductible is met.
- You pay 20 percent coinsurance plus any difference between the doctor's charge and Medicare's approved amount.
- The initial allergy testing that determines which shots you need is also covered under Part B.
- Allergy shots given at home or purchased over the counter are not covered by Medicare.
- Medigap or Medicare Advantage plans may cover some or all of your 20 percent coinsurance, depending on your plan.
How the 20 percent coinsurance works in practice
After you meet your Part B deductible for the year, Medicare pays its 80 percent share based on what it calls the "approved amount" — not what your doctor actually charges. If your allergist charges $150 per shot but Medicare's approved amount in your area is $100, Medicare pays $80 (80 percent of $100). You owe $20 plus the $50 difference, totaling $70 out of pocket.
This difference, called balance billing, varies by location and provider. Doctors who accept Medicare assignment agree not to bill you more than the approved amount, so you would owe only the $20 coinsurance. Doctors who do not accept assignment can charge more. Before starting allergy shots, ask your allergist whether they accept Medicare assignment.
What happens during the allergy testing phase
Before you receive allergy shots, you need allergy testing to identify which substances trigger your symptoms. Skin testing (scratch test or intradermal test) and blood tests are both covered by Medicare Part B under the same 80/20 split after your deductible.
Testing is usually done in one or two visits and happens before the shot series begins. The allergist uses the results to create a custom serum — the liquid in your shots. This preparation is covered as part of your treatment, not billed separately as a compounded medication.
The build-up phase and maintenance phase
Allergy shots follow two stages. During the build-up phase, you receive injections weekly or twice weekly for three to six months, with gradually increasing doses. During the maintenance phase, you receive shots every two to four weeks for three to five years. Both phases are covered by Medicare at the same 80/20 rate.
You pay coinsurance for each visit, not for the entire course of treatment upfront. If you receive shots weekly, you will have a copay or coinsurance each week. Some allergists bundle multiple injections into one visit to reduce the number of office visits and therefore your total out-of-pocket costs.
Medicare Advantage and Medigap coverage of allergy shots
If you have a Medicare Advantage plan (Part C), coverage of allergy shots depends on your specific plan. Most Advantage plans cover immunotherapy, but the copay or coinsurance amount varies. Some plans charge a flat copay per visit (for example, $25), while others use coinsurance. Check your plan documents or call the plan directly to learn your exact cost.
If you have a Medigap plan (supplemental insurance), certain plans cover the 20 percent coinsurance you owe after Medicare pays. Plans C, D, F, G, M, and N all cover Part B coinsurance. This means if Medicare approves $100 for your shot and pays $80, your Medigap plan pays the $20 you would otherwise owe. You would have no out-of-pocket cost for the shot itself (though you still pay your Medigap premium).
What Medicare does not cover for allergies
Medicare Part B does not cover allergy shots given at home, even if a nurse administers them. Home-based immunotherapy is not a covered service. Over-the-counter allergy medications, antihistamines, and decongestants are not covered by any part of Medicare.
Sublingual immunotherapy tablets (such as Oralair or Palforzia) are not covered by Medicare. These are taken under the tongue instead of by injection. If your allergist recommends this form of treatment, you would pay the full cost out of pocket unless you have a separate prescription drug plan through an employer or private insurer.
How to reduce your out-of-pocket costs
If you have not met your Part B deductible for the year, consider scheduling your allergy testing and first shots after January 1, when the deductible resets. This spreads your costs across two calendar years if you are near the deductible limit late in the year.
Ask your allergist's office whether they offer package pricing or bundled visits that combine multiple injections into one appointment. Fewer visits mean fewer coinsurance payments. If you have a Medigap plan, confirm it covers Part B coinsurance before your first appointment so you understand your true cost. If you have a Medicare Advantage plan, call your plan to ask whether there is an in-network allergist who charges lower copays or whether the plan has any limits on the number of shots covered per year.
Frequently Asked Questions
Do I need a referral from my primary care doctor to see an allergist?
Medicare Part B does not require a referral to see an allergist or any other specialist. You can schedule directly with an allergist who accepts Medicare. However, some Medicare Advantage plans do require referrals, so check your plan documents or call your plan before making an appointment.
Are allergy shots covered if I have only Part A?
No. Allergy shots are an outpatient service covered only by Part B. If you have Part A but not Part B, you would pay the full cost. You can enroll in Part B during the annual enrollment period or within three months of turning 65.
What if my allergist is out of network for my Medicare Advantage plan?
Out-of-network care in a Medicare Advantage plan usually costs more or may not be covered at all, depending on your plan. Some plans cover emergency or urgent out-of-network care but not routine allergy shots. Call your plan to ask whether out-of-network allergy treatment is covered and what your cost would be.
Can I switch from allergy shots to sublingual tablets and have Medicare cover the tablets?
No. Medicare does not cover sublingual immunotherapy tablets. If your allergist recommends switching from shots to tablets, you would need to pay out of pocket for the tablets. The shots themselves remain covered if you continue receiving them in an office setting.
Does Medicare cover allergy shots for pet allergies?
Yes, as long as a doctor prescribes them for a documented allergic condition. Pet allergies are treated the same way as pollen or dust allergies. Medicare covers the testing, serum preparation, and injections regardless of what substance you are allergic to.