Usually, when we hear the term allergies, we think of seasonal allergies that many of us suffer from. However, hay fever isn’t the only type of allergies. Other common forms of allergies are eczema, asthma, and food allergies.
More than 50 million Americans are affected by some type of allergy. Out of that 50 million, 35 million have eczema and 26 million have asthma. Often, when someone suffers from one type of allergy, he suffers from another as well.
Some allergies, such as food allergies, resolve as we age. However, allergies like eczema and asthma can be lifelong conditions and worsen over time. Here’s how Medicare covers specific types of allergies.
Medicare Coverage for Hay Fever
The technical term for hay fever is allergic rhinitis. This is the typical runny nose, itchy eyes, and sneeze-filled allergies most of us experience throughout the year. Some people’s allergic rhinitis is more chronic than others. If you suffer from chronic allergic rhinitis, you have likely considered allergy testing.
Medicare covers percutaneous and intradermal allergy testing under certain circumstances.
In a percutaneous allergy test, the doctor will scratch or prick your skin. During an intradermal test, a small amount of allergen is injected into the top layer of the skin.
Medicare will cover these allergy tests if your allergic history is chronic, and your symptoms aren’t controllable by other means of treatment. If your test is positive, Medicare will generally cover your allergy injections. Immunotherapy is created for you based on your test results. Allergy injections are usually given in a clinic setting, such as your doctor’s office. When medication is administered in this way, Medicare Part B covers it.
Medicare Part B also covers diagnostic tests, such as allergy tests. With Part B, you are responsible for a $185 annual deductible. Once that has been met, Part B will cover 80 percent of both your test and your shots.
Medicare Coverage for Eczema
Atopic dermatitis, commonly known as eczema, is usually first noticed during early childhood. The itchy rash is most commonly found on the arms and the backs of the knees. Technically there is no cure for eczema, just precautions, and treatments to minimize flare-ups but you can try natural treatment for eczema with home remedies.
Doctors are usually able to diagnosis eczema be reviewing your medical history and identifying the rash as eczema.
Eczema is usually managed with medications. Prescription drugs are covered under Medicare Part D. Each plan has its own drug formulary, which is a list of drugs the plan covers and your copayment for each.
Every Part D plan works the same as far as how you pay. The first payment stage is the deductible stage. As of 2019, the highest deductible a Part D plan can have is $415. Once that has been met, you move to the second payment stage, initial coverage. This stage is where you pay a copay for each drug.
After you and your carrier pay a total of $3,820, you’ll move to the next stage, the coverage gap. This stage is usually the most expensive stage, and you can get out of it once you and your plan have spent $5,100 (including the $3,820). After that, you will be in the catastrophic coverage stage where the carrier covers 95 percent of the drug cost.
If you receive a procedure or treatment such as phototherapy for your eczema, Medicare Part B will cover it if it is deemed medically necessary. You pay for these procedures just like you would pay for the allergy test mentioned above.
Medicare Coverage for Asthma
Many people who suffer from chronic allergies also have asthma. Asthma is a condition that makes it hard to breathe due to the swelling and tightening of airways. Certain allergens can cause a person’s airways to tighten, resulting in an asthma attack.
Some things that Medicare covers for asthma patients are asthma medications and durable medical equipment such as nebulizers. Oral asthma medications will be covered by Part D, just like eczema medications are. Be sure to check the Part D plan’s formulary prior to enrolling to make sure they cover your asthma inhalers.
Nebulizers and oxygen equipment are considered durable medical equipment (DME). Medicare Part B covers medically necessary DME that is prescribed by a doctor. If you require medication to be used in conjunction with your DME, Part B will also cover that. For instance, if you use a nebulizer to receive your albuterol medication, Part B will be in charge or coverage rather than Part D.
Medicare Part B may also cover procedures that test the function of your lungs and airways. If the test is deemed medically necessary, Part B will cover procedures such as a spirometry, a post-bronchodilator test, and a pulmonary function test.
Medicare Plans Can Help
Medicare plans such as Medigap and Medicare Advantage plans can help lower your out-of-pocket costs. With Original Medicare (Part A and Part B), there is no cap on your out-of-pocket costs.
However, with a Medicare Advantage plan or a Medigap plan, such as Plan G, you are protected by either a maximum out-of-pocket or little to no out-of-pocket responsibility. Figure out which plan is best for you by reviewing each plan’s benefits, premiums, copays, deductibles, and coinsurance.
Danielle K Roberts is the co-founder of Boomer Benefits where she and her team help baby boomers navigate their Medicare insurance options. She is a member of the Forbes Finance Council and writes frequently about Medicare, retirement and personal finance.