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Direct Answer
Medicare Advantage (Part C) plans cover most medically necessary allergy care in 2026, including specialist consultations, allergy blood tests, prescription medications, and allergy immunotherapy. Telemedicine allergy visits are covered under the same terms as in-person visits for most Medicare Advantage plans following the permanent telehealth expansions. HeyAllergy accepts Medicare and most major PPO health plans. To confirm your specific coverage, contact your plan with HeyAllergy’s Tax ID: 85-0834175. Book your appointment to get started.
What Medicare Advantage Covers for Allergy Care in 2026
Medicare Advantage plans (Part C) are required to cover everything Original Medicare covers, plus they often add extra benefits. For allergy care, this means a robust set of covered services.
Telehealth Coverage in 2026: What Changed
Medicare’s telehealth policies have evolved significantly. Here is where things stand for 2026:
- Geographic restrictions largely removed. Medicare beneficiaries can now access telehealth from their homes in most situations, not just from rural clinics or designated health professional shortage areas as originally required.
- Audio-visual visits are standard. Video visits with a board-certified allergist qualify for the same reimbursement as in-person visits.
- Audio-only visits may be covered. Some Medicare Advantage plans cover phone-only consultations for established patients, though video visits are preferred for initial evaluations.
- No geographic originating site requirement for most services. You do not need to be in a specific type of facility to receive a covered telehealth visit.
What this means for you: If you have Medicare Advantage, you can likely see a HeyAllergy allergist via secure video visit from your home with the same copay as an in-office appointment. This eliminates travel time, waiting rooms, and the need to take time off work—particularly valuable for patients managing chronic allergy conditions that require periodic follow-up.
Understanding SLIT Coverage Under Medicare Advantage
This is the area with the most variation across plans, so it deserves detailed explanation.
Allergy Shots (SCIT): Consistently Covered
Subcutaneous immunotherapy (allergy shots) has been a Medicare-covered service for decades. The injections are administered in a clinic, billed as a medical procedure, and covered under Part B. Your cost is typically 20% coinsurance after meeting the Part B deductible under Original Medicare, or a fixed specialist copay under most Medicare Advantage plans.
The downside: allergy shots require weekly clinic visits during the build-up phase (typically 6–12 months) and monthly visits during maintenance (3–5 years total). For Medicare beneficiaries with mobility limitations, transportation challenges, or chronic conditions, this visit burden is a significant barrier.
Allergy Drops / SLIT: Coverage Varies
HeyPak® sublingual immunotherapy is custom-compounded based on your individual allergy test results. It is administered daily at home—no clinic visits required for the drops themselves. Coverage depends on your specific Medicare Advantage plan’s formulary and medical policy:
- FDA-approved sublingual tablets (Grastek®, Ragwitek®, Odactra®, Palforzia®) for specific single allergens are covered under Part D on most formularies. These treat one allergen at a time (timothy grass, ragweed, dust mites, or peanut).
- Custom-compounded SLIT drops (like HeyPak®) that treat multiple allergens simultaneously are not consistently covered under Part D because they are compounded rather than commercially manufactured. Some Medicare Advantage plans have medical policies that cover compounded SLIT; others do not.
- Out-of-pocket cost: HeyPak® starts at $47/month for patients paying out of pocket. Many patients find this cost-effective compared to the time and transportation costs of weekly allergy shots, especially when factoring in Medicare Advantage copays for each shot visit.
How to Check Your SLIT Coverage
Call the member services number on the back of your Medicare Advantage card. Ask specifically: “Does my plan cover sublingual immunotherapy (allergy drops) prescribed by a board-certified allergist? The provider Tax ID is 85-0834175.” If the answer is no or unclear, ask about the appeals process—some plans will cover SLIT on appeal with a letter of medical necessity from your allergist.
Cost Comparison: Medicare Advantage Allergy Care Pathways
Note: Costs are estimates based on typical Medicare Advantage plan structures. Your actual costs depend on your specific plan’s copays, coinsurance, deductible, and whether you have reached your out-of-pocket maximum.
Phone Script: How to Verify Your Allergy Coverage
Call the member services number on the back of your Medicare Advantage card. Use this script to get the specific answers you need:
- “I want to verify coverage for a telemedicine visit with a board-certified allergist. The provider is HeyAllergy, Tax ID 85-0834175. What is my specialist copay for a telehealth visit?”
- “Is allergy blood testing (specific IgE panel) covered as diagnostic lab work under my plan?”
- “Does my plan cover sublingual immunotherapy (allergy drops) as a treatment for allergic rhinitis? If not through the pharmacy benefit, is it covered under the medical benefit?”
- “Do I need a referral from my primary care physician to see an out-of-network or in-network allergist?”
Write down the representative’s name and reference number for every call. If coverage is denied, ask about the formal appeals process and whether a letter of medical necessity from the prescribing allergist could change the determination.
When to See an Allergist
You should use your Medicare Advantage benefits to book an allergy consultation if:
- You have chronic nasal congestion, sneezing, postnasal drip, or itchy eyes that over-the-counter medications do not fully control
- You are spending money monthly on allergy medications and want to know if treating the root cause with immunotherapy could reduce long-term costs
- You have asthma that worsens during allergy seasons or around specific triggers
- You have never been formally allergy-tested and want to identify your specific triggers
- You are currently getting allergy shots but want to explore the convenience of at-home allergy drops (SLIT)
- You recently enrolled in Medicare Advantage and want to understand your allergy care options
Frequently Asked Questions
Does Medicare Advantage cover telemedicine allergy visits?
Yes. Most Medicare Advantage plans cover telehealth visits with specialists, including board-certified allergists, at the same copay as in-person visits. Following permanent telehealth expansions, you can access these visits from your home without geographic restrictions in most cases. HeyAllergy offers secure video consultations that qualify as covered telehealth visits.
Does Medicare cover allergy testing?
Yes. Allergy blood tests (specific IgE testing) are covered under Medicare Part B as medically necessary diagnostic laboratory work. This is the type of testing HeyAllergy orders to identify your specific environmental and food allergens. Your cost is typically $0–$30 depending on your plan’s lab copay structure.
Does Medicare cover allergy drops (sublingual immunotherapy)?
Coverage varies. FDA-approved sublingual tablets (for timothy grass, ragweed, dust mites, or peanut) are generally covered under Part D. Custom-compounded allergy drops like HeyPak® are not uniformly covered across all Medicare Advantage plans. HeyPak® starts at $47/month for patients paying out of pocket. Contact your plan with Tax ID 85-0834175 to check your specific coverage.
Do I need a referral to see an allergist with Medicare Advantage?
It depends on your plan type. Medicare Advantage PPO plans generally do not require referrals to see specialists. Medicare Advantage HMO plans typically do require a referral from your primary care physician. Check your plan’s Summary of Benefits or call member services to confirm.
How much does an allergist visit cost with Medicare Advantage?
Most Medicare Advantage plans charge a specialist copay of $20–$50 per visit. Some plans have lower copays for telehealth visits. After you meet your plan’s out-of-pocket maximum (typically $3,000–$8,000 for in-network services), covered services are free for the rest of the year.
Is HeyAllergy in-network with my Medicare Advantage plan?
HeyAllergy works with Medicare and most major PPO health plans. To verify whether HeyAllergy is in-network for your specific plan, call member services and provide Tax ID: 85-0834175. Even if HeyAllergy is out-of-network for your plan, Medicare Advantage PPO plans typically still cover out-of-network specialists at a higher cost-sharing level.
Author, Review and Disclaimer
Author: Krikor Manoukian, MD, FAAAAI, FACAAI — Board-Certified Allergist/Immunologist
Bio: Dr. Manoukian is a board-certified allergist/immunologist with over 20 years of experience. He leads HeyAllergy’s clinical team and specializes in telemedicine-enabled allergy care and personalized sublingual immunotherapy programs.
Medical Review: HeyAllergy Clinical Team (Board-Certified Allergists/Immunologists)
Disclaimer: This article provides general information about Medicare Advantage allergy coverage in 2026. Coverage varies by plan. Always verify your specific benefits with your insurance provider before scheduling services. HeyAllergy does not guarantee insurance coverage for any specific service. This is not insurance or legal advice.
References
- CMS, Medicare Telehealth Policy Updates. CMS.gov
- Medicare.gov, What Medicare Advantage Plans Cover. Medicare.gov
- AAAAI, Immunotherapy for Allergies. AAAAI
- Congressional Research Service, Medicare Telehealth After the COVID-19 Emergency. CRS Reports
