Key takeaways
- Medicare Part B covers most of the cost of allergy shots if a doctor considers them medically necessary.
- Allergy shots can help relieve symptoms when other treatments don’t help.
- The out-of-pocket cost depends on what type of Medicare coverage you have.
Allergies are chronic immune reactions to allergens like pollen, grass, food, and other irritants. Allergy shots may help relieve symptoms of severe chronic allergies.
Allergic rhinitis, or hay fever, is a common type of allergy. It affects up to
Allergies can develop at any time or age, and sudden reactions are possible. They can be seasonal or year-round, with mild to severe symptoms.
Allergy shots can help relieve your symptoms when other treatments don’t help. Medicare Part B and Medicare Advantage (Part C) may cover most of the cost of allergy shots if your doctor believes they’re medically necessary.
Allergy immunotherapy shots help make your body less sensitive to allergen triggers by introducing them in small doses over time. However, they don’t work immediately or for all types of allergies.
Most people need to take shots for several years to see long-term benefits. As such, this treatment is highly individualistic, which makes it hard for Medicare to set precise guidelines on coverage.
That means coverage decisions are made on a case-by-case basis. In general, the cost and multiple office visits can make it difficult to continue as a long-term therapy.
To get Medicare coverage for allergy shots, your doctor must provide evidence that the treatment is necessary. How long you’ll get the shots depends on your doctor’s recommendation.
However, after 2 years, Medicare may refuse coverage if you do not experience a reduction in symptoms, an increased tolerance to the allergen, or a reduced use of allergy medication.
Your doctor must document that allergy shots are medically necessary because your symptoms are severe and other treatment options haven’t helped.
Medicare and allergy testing
If you suspect you may have allergies, Medicare will likely cover allergy testing. Since this is an outpatient procedure, coverage would fall under Part B. To be eligible, you must meet certain requirements and undergo examination by a physician.
Learn more about Medicare coverage for allergy testing.
Medicare Part B
Medicare Part B is medical insurance for outpatient services. It may cover up to 80% of your allergy shot costs if you meet eligibility requirements.
You’ll also pay your monthly premiums, deductibles, and out-of-pocket costs.
Shots are given at the doctor’s office, and you may have separate copays per visit. Consider checking with Medicare and your doctor’s office before your appointment to determine your out-of-pocket costs.
Medicare Advantage
Medicare Advantage, or Medicare Part C, plans may also cover allergy shots, but the amount of coverage varies by plan. Medicare Advantage plans are required to cover at least as much as Part B.
You can check with your plan provider to ask about costs and coverage for allergy shots.
Medicare Advantage plans typically offer more benefits than plans under Original Medicare (parts A and B). These extra benefits may include vision, dental, and hearing care.
Your copays, deductibles, and premiums may differ depending on your insurance provider, the coverage options you choose, and your location.
Medicare Part D
Medicare Part D plans cover prescription medications that you take at home. Since allergy shots are given at a doctor’s office, they typically won’t be covered under a Part D plan.
According to a 2021 study looking at allergy-related treatments and their costs, allergy shots were billed to insurance about 78% of the time, costing somewhere in the range of $748 to $849 per claim.
About 21% of these claims had expenses exceeding $1,000. That said, the research does not indicate what expense each person incurred out of pocket.
The cost with Medicare can vary depending on your plan’s coverage and whether you meet Medicare’s eligibility requirements.
Factors that affect your costs include:
- how often you receive the shots, which tend to be once weekly but may be more frequent
- the allergen serum itself
- administration fees for the doctor and medical facility
- your specific Medicare coverage
Costs with Original Medicare
If your doctor says allergy shots are medically necessary and Medicare approves coverage, Part B will pay 80% of the costs after you reach your deductible. You’ll pay the remaining 20% out of pocket plus any additional copays. In 2025, the Part B deductible is $257.
With Part B, it’s important to visit providers who participate in Medicare and accept assignment to avoid higher costs.
Costs with Medicare Advantage
Medicare Advantage plans may also cover allergy shots, but coverage and cost can depend on the plan and include copays and coinsurance. Since costs can vary, check with your plan ahead of time about the exact amount you’ll need to pay for your immunotherapy injections.
Medicare Advantage plans often have in-network providers, so be sure to visit covered providers for allergy testing and shots. This is especially important if you live in an area with limited access to allergy and immunology specialists for testing and shots.
Costs with Medigap
Since allergy shots are needed several times per year, a supplemental plan through Medigap may help offset some of your out-of-pocket costs. Medigap plans help cover the out-of-pocket costs of Original Medicare. They are not available to people enrolled in Medicare Advantage plans.
There are 10 different Medigap plan options. You can search for plans offered in your area and decide which is best for your needs and budget.
Immunotherapy can help manage some types of severe chronic allergies in the long term. However, there is no cure for allergies, and allergy shots don’t work for all types.
Different parts of Medicare may cover some of the costs of your allergy shots. But it’s important to check with your doctor and plan ahead of time to avoid unexpected costs.