Medicare Part B covers allergy shots, but only when a doctor prescribes them for a diagnosed allergic condition
Yes, Medicare Part B covers allergy shots (immunotherapy) when they are medically necessary. Medicare pays 80 percent of the cost after you meet your Part B deductible for the year. You pay the remaining 20 percent as coinsurance. The shots themselves are covered, along with the office visit where you receive them.
The key requirement is that a doctor must diagnose you with an allergic condition and determine that immunotherapy is the appropriate treatment. Allergy testing to identify what you are allergic to is also covered by Medicare Part B under the same terms.
Coverage does not depend on which specific allergens you react to or how many shots you need. Medicare covers the full course of treatment as long as your doctor continues to prescribe it.
Key Takeaways
- Medicare Part B covers allergy shots at 80 percent after you pay your annual deductible, with you responsible for 20 percent coinsurance.
- Your doctor must prescribe the shots for a diagnosed allergic condition; Medicare does not cover shots for prevention or wellness.
- The cost you pay depends on where you receive the shots — a hospital outpatient department, an allergist's office, or a clinic — because facility fees vary.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower because those plans often cover part or all of the 20 percent coinsurance.
- Allergy testing that leads to the shots is also covered by Medicare Part B under the same 80/20 split.
How the 80/20 cost split works in practice
After you meet your Part B deductible (which is $240 in 2024, though this amount changes yearly), Medicare pays its 80 percent share of the approved amount for each shot and office visit. You are responsible for the remaining 20 percent. This coinsurance applies to every visit, not just the first one.
The actual dollar amount you pay per visit depends on what Medicare's approved amount is in your area and where you receive the shots. An allergist's private office, a hospital outpatient clinic, and a community health center may all have different approved amounts. You can call the provider's billing office and ask what the Medicare-approved amount is for an allergy injection visit in your area.
If you have not yet met your Part B deductible for the year, you pay 100 percent of the cost until you reach $240. Once you hit that deductible, Medicare's 80 percent coverage kicks in for the rest of the year.
What happens if you have a Medigap or Medicare Advantage plan
A Medigap (supplemental insurance) plan can cover some or all of the 20 percent coinsurance you would otherwise owe. The exact amount depends on which Medigap plan you have — some cover the full 20 percent, others cover part of it. You pay a monthly premium for Medigap, but it can significantly reduce your out-of-pocket costs for allergy shots.
A Medicare Advantage plan (Part C) works differently. Instead of the 80/20 split, your plan sets its own copay or coinsurance amount for allergy shots. Some Medicare Advantage plans cover allergy shots with a small copay per visit; others may require coinsurance. You need to check your specific plan's formulary or call the plan to find out what you will pay.
If you are considering switching to a Medigap or Medicare Advantage plan, ask whether allergy shots are covered and what your out-of-pocket cost will be. This information is available in each plan's summary of benefits or by calling the plan directly.
Where you can receive allergy shots under Medicare
Medicare covers allergy shots in several settings: an allergist's private office, a hospital outpatient department, an urgent care clinic, or a community health center. The location does not affect whether Medicare covers the shots, but it does affect the facility fee and your out-of-pocket cost.
Hospital outpatient departments typically charge higher facility fees than private allergist offices, which means your 20 percent coinsurance will be higher at a hospital. If you have a choice and cost matters to you, ask your doctor whether the shots can be given in an office setting rather than a hospital outpatient clinic.
Some allergists' offices are in-network with Medicare Advantage plans and some are not. If you have a Medicare Advantage plan, confirm that your allergist is in-network before scheduling, or your out-of-pocket cost may be much higher.
Allergy testing is also covered by Medicare
Before you receive allergy shots, you usually need allergy testing to identify which allergens trigger your symptoms. Medicare Part B covers allergy testing (skin tests and blood tests) at the same 80/20 rate as the shots themselves. The testing must be ordered by your doctor as part of diagnosing an allergic condition.
Allergy testing can be done in an allergist's office, a hospital outpatient setting, or a primary care doctor's office. Like allergy shots, the location affects your out-of-pocket cost because of facility fees. The test results help your doctor decide whether immunotherapy is the right treatment for you.
What Medicare does not cover related to allergies
Medicare does not cover allergy shots given for prevention or wellness if you do not have a diagnosed allergic condition. For example, if you want shots to prevent seasonal allergies before pollen season starts but you have no current symptoms or diagnosis, Medicare will not pay for them.
Medicare also does not cover over-the-counter allergy medications, antihistamines, or decongestants. If your doctor prescribes a brand-name allergy medication, Medicare Part D (prescription drug coverage) may cover it, but that is separate from Part B coverage of the shots.
Sublingual immunotherapy (allergy tablets that dissolve under the tongue) is not covered by Medicare. Only injected allergy shots are covered under Part B.
How to find an allergist who accepts Medicare
You can search for allergists who accept Medicare through Medicare.gov's provider search tool. Go to the "Care Provider" section, select your state, and search for allergists or immunologists in your area. The search results show which providers accept Medicare assignment, meaning they accept Medicare's approved amount as full payment for their services (after you pay your deductible and coinsurance).
You can also call your primary care doctor's office and ask for a referral to an allergist who accepts Medicare. Many primary care offices work regularly with allergists and know which ones are reliable and accept Medicare.
Before your first appointment, call the allergist's office and confirm that they accept Medicare and that allergy shots are available at that location. Some offices do allergy testing but refer patients elsewhere for the shots, which can complicate your care.
Frequently Asked Questions
Do I need a referral from my primary care doctor to see an allergist for shots?
Medicare Part B does not require a referral to see an allergist. You can schedule an appointment directly with an allergist who accepts Medicare. However, your primary care doctor can provide a referral if you want one, and some Medicare Advantage plans do require a referral — check your plan's rules.
What if my allergist says I need shots twice a week for several months?
Medicare covers the full course of immunotherapy as prescribed by your doctor. If your allergist determines you need two shots per week, Medicare will cover all of them at the 80/20 rate. The total cost to you depends on how many visits you have and whether you have met your deductible.
Can I get allergy shots at an urgent care clinic instead of an allergist's office?
Some urgent care clinics offer allergy shots, and Medicare covers them there. However, most allergy shots are given in allergists' offices because allergists specialize in diagnosing allergies and managing immunotherapy. Ask your doctor where the shots should be given for your specific condition.
If I switch from Original Medicare to a Medicare Advantage plan, will my allergy shots still be covered?
Medicare Advantage plans must cover allergy shots, but the cost to you may be different. Each plan sets its own copay or coinsurance. Before you switch, call the Medicare Advantage plan and ask what you will pay for allergy shots, and confirm that your allergist is in-network.
Are allergy shots covered if I am still working and have employer health insurance?
If you are under 65 and have employer insurance, your employer plan is primary and Medicare is secondary. Your employer plan decides whether allergy shots are covered. Once you turn 65 or become may be able to access for Medicare, Medicare Part B becomes primary for most services, including allergy shots.