Medicare covers allergy testing, but only certain types and only when a doctor orders it for a medical reason

Medicare Part B covers allergy testing if your doctor believes you have an allergic condition that needs diagnosis. The test must be ordered by a physician, and Medicare will pay its share of the cost. However, Medicare does not cover allergy testing done for screening purposes — that is, testing when you have no symptoms or medical reason to suspect an allergy.

The amount you pay depends on which type of test your doctor orders and whether you have met your Part B deductible for the year. Most allergy tests are covered at 80 percent after you pay the deductible, meaning you cover 20 percent of the Medicare-approved amount. If your doctor orders the test at an out-of-network facility, you may owe more.

Key Takeaways

  • Medicare Part B covers allergy testing when ordered by a doctor for a suspected allergic condition, not for screening without symptoms.
  • You pay 20 percent of the Medicare-approved cost after meeting your annual Part B deductible, which is $240 in 2024.
  • Skin prick tests and intradermal tests are the most common types covered; blood tests for allergies are covered but may have different cost-sharing rules.
  • Testing at an out-of-network provider may result in higher out-of-pocket costs because Medicare pays less.
  • Your Medigap or Medicare Advantage plan may cover some or all of your 20 percent coinsurance, depending on your specific plan.

What types of allergy tests Medicare covers

The most common allergy tests Medicare covers are skin prick tests and intradermal tests. In a skin prick test, the doctor places a small amount of allergen on your skin and pricks the surface to see if a reaction develops. An intradermal test injects a small amount of allergen under the skin. Both are performed in a doctor's office or allergy clinic and take 15 to 30 minutes.

Medicare also covers blood tests for allergies, sometimes called RAST tests or specific IgE tests. These measure antibodies in your blood that react to specific allergens. Blood tests are useful if you cannot have skin tests — for example, if you take certain medications or have severe skin conditions — or if your doctor wants to confirm skin test results.

Medicare does not cover allergy testing done purely for information or peace of mind when you have no symptoms. It also does not cover comprehensive screening panels that test for dozens of allergens at once without a medical reason to suspect exposure to those specific substances.

How much you will pay out of pocket

Your out-of-pocket cost for allergy testing depends on whether you have met your Part B deductible. The Part B deductible for 2024 is $240 per year. Once you meet this deductible, Medicare pays 80 percent of the approved cost and you pay 20 percent.

If you have not met your deductible yet, you pay the full cost of the test until you reach $240. After that, you pay 20 percent coinsurance. For example, if the Medicare-approved cost of a skin prick test is $150, and you have already met your deductible, you would pay $30 and Medicare would pay $120.

If your doctor orders the test at an out-of-network facility, Medicare may pay less than it would at a network facility. You would then owe the difference between what Medicare approves and what the facility charges, in addition to your 20 percent coinsurance. Always ask your doctor's office whether the testing facility is in Medicare's network.

When your Medigap or Medicare Advantage plan helps with costs

If you have a Medigap policy, your plan may cover some or all of the 20 percent coinsurance you owe for allergy testing. Most Medigap plans cover coinsurance for Part B services, though the exact amount varies by plan letter. Check your policy documents or call your Medigap insurer to confirm what allergy testing costs you would owe.

If you have a Medicare Advantage plan, your coverage for allergy testing works differently. Advantage plans set their own rules for what they cover and how much you pay. Some plans cover allergy testing with a copay (a fixed amount like $20 or $30), while others use coinsurance. You should contact your Advantage plan before scheduling a test to learn your exact cost.

What to ask your doctor before getting tested

Before your doctor orders an allergy test, ask which type of test they recommend and why. Ask whether the testing facility is in-network with Medicare. If you have a Medigap or Advantage plan, ask your doctor's office to verify your coverage with your plan before the test is done — this prevents surprises at the billing stage.

Ask your doctor how the test results will change your treatment. Allergy testing is most useful when the results will lead to a specific action, such as avoiding a substance, starting medication, or pursuing immunotherapy. If your doctor cannot explain how the test will affect your care, it may not be medically necessary.

If cost is a concern, tell your doctor. They may be able to order a blood test instead of a skin test, or test for only the allergens most likely to be causing your symptoms, rather than a broad panel.

When to seek allergy testing through Medicare

You should consider allergy testing if you have symptoms that suggest an allergic reaction — such as sneezing, itching, hives, or swelling — and your doctor thinks identifying the allergen would help treat you. Testing is particularly useful if your symptoms are seasonal or happen after exposure to specific substances, or if you have tried over-the-counter allergy medications without relief.

Allergy testing is also appropriate if you have asthma or eczema and your doctor suspects allergies are making those conditions worse. In these cases, identifying and avoiding the allergen can improve your symptoms and reduce the need for other medications.

Do not pursue allergy testing just to find out what you might be allergic to if you have no symptoms. Medicare will not cover it, and you would pay the full cost out of pocket.

Frequently Asked Questions

Does Medicare cover allergy shots or immunotherapy after testing?

Yes, Medicare Part B covers allergy immunotherapy (allergy shots) when ordered by a doctor. You pay 20 percent coinsurance after your deductible, the same as for the testing itself. Immunotherapy requires multiple visits over months or years, so your costs will add up over time. Your Medigap plan may help cover coinsurance for these visits as well.

What if I want to test for allergies but have no symptoms?

Medicare will not cover testing without a medical reason. You would pay the full cost out of pocket. If you want screening for peace of mind, ask your doctor whether it is worth the expense given that you have no symptoms to treat.

Can I get allergy testing at an urgent care or retail clinic?

Medicare covers allergy testing ordered by any doctor, including those at urgent care clinics, as long as there is a medical reason for the test. However, urgent care facilities may not perform allergy testing — most allergy testing is done in a doctor's office or a specialty allergy clinic. Ask your primary care doctor for a referral to an allergy specialist if you need testing.

Will my out-of-pocket cost be different if I see an allergist instead of my primary care doctor?

No, your Medicare cost-sharing is the same regardless of which doctor orders the test. However, you may owe a copay to see the allergist if you have a Medicare Advantage plan. Check your plan's rules for specialist visits before scheduling an appointment.

Do I need a referral from my primary care doctor to get allergy testing?

Medicare does not require a referral, but your Medicare Advantage plan may. Check your plan documents or call your plan to confirm. Even if a referral is not required, your primary care doctor can help determine whether testing is medically necessary and refer you to a may have access to allergist.