Living with allergies in North Carolina can be challenging—several NC cities rank among the nation's worst for pollen. Here's what triggers allergies in our state, treatment options, and how insurance covers allergy testing and immunotherapy.
North Carolina is a wonderful place to live, but if you suffer from seasonal allergies, you know it can also be one of the most challenging. According to the Asthma and Allergy Foundation of America's 2025 Allergy Capitals report, several North Carolina cities rank among the worst in the nation for allergy sufferers:
Raleigh: #7 in the U.S. (worse-than-average pollen, medication use, and limited allergy specialists)
Greensboro: #10 (jumped nine spots from 2024)
Winston-Salem: #15 (jumped 32 spots from 2024)
Charlotte: #18
Durham: #35
If you suffer from allergies, you may experience itchy eyes, coughing, a runny or stuffy nose, and sneezing. While avoiding triggers and trying over-the-counter medications can help, sometimes you need professional treatment—including allergy testing or immunotherapy. Understanding your insurance coverage for these services is important.
Pollen: Three Overlapping Seasons
North Carolina has three distinct pollen seasons that often overlap, making it especially tough for allergy sufferers. Pollen comes primarily from wind-pollinated plants like trees, grass, and weeds—not from flowers.
Tree pollen (March–June, peaks in April): Oak, hickory, American beech, river birch, cedar, and pine are major triggers. In 2024, Raleigh had its warmest spring since records began in 1887, extending the tree pollen season.
Grass pollen (mid-spring through fall, peaks in April–May): Common culprits include Bermuda grass, centipede, ryegrass, tall fescue, Kentucky bluegrass, and zoysia. If you're planting a lawn, tall fescue is less likely to trigger allergies.
Weed pollen (August–winter, peaks in September): Ragweed is the biggest offender, particularly in rural areas around Charlotte. Late February marks the start of high pollen levels in NC that can continue into fall.
Mold
North Carolina's humid climate—especially in summer—creates ideal conditions for mold growth. Mold spores can cause symptoms similar to pollen allergies: runny nose, cough, itchy eyes, sneezing, and sometimes headaches or rashes. Mold counts tend to be higher at night, so keeping windows closed overnight can help. Using a dehumidifier indoors can discourage mold growth.
Dust Mites
Dust mites are microscopic insects that live indoors year-round. They're common throughout America and can cause nasal congestion, coughing, facial pressure, and itchy or watery eyes—especially in children. Washing bedding weekly in hot water and using allergy-proof covers on mattresses and pillows can help reduce exposure.
Avoid outdoor activities during peak pollen times: 5 am–10 am is prime pollen time; 10 am–3 pm is worst for ragweed. Head outside in late afternoon or early evening if possible.
Delegate lawn care: Have a family member cut the grass during pollen season, or hire a lawn service.
Clean regularly: Dust, wash bedding, and vacuum frequently to remove allergens—especially dust mites.
Monitor pollen counts: Check local pollen forecasts online to plan outdoor activities.
Start medications early: Over-the-counter nasal sprays work best when started before symptoms peak—consider beginning in early March for spring allergies.
Get tested: Consider allergy testing to identify your specific triggers and better protect yourself.
If you're wondering whether Medicare covers allergy testing and treatment, the answer is generally yes—when it's medically necessary.
Medicare Coverage for Allergy Testing
Medicare Part B covers allergy testing as part of "clinical diagnostic laboratory services" when:
A Medicare-enrolled physician prescribes the test
The test is deemed medically necessary based on your symptoms and medical history
Previous treatments (such as over-the-counter medications) haven't adequately controlled your symptoms
The testing is part of an approved treatment plan
Types of allergy tests covered by Medicare:
Skin prick (scratch) test: Small amounts of allergens are placed on your skin and gently pricked. A small red bump indicates an allergy.
Intradermal test: A diluted allergen is injected just below the skin's surface—slightly more sensitive than scratch testing.
Blood tests (IgE testing): Measure allergen-specific antibodies in your blood.
Food challenge testing: Monitored by an allergist who gradually introduces small amounts of suspected food allergens.
Your costs (2025): After meeting your annual Part B deductible ($257 in 2025, $283 in 2026), Medicare typically pays 80% of the approved amount. You pay the remaining 20%—unless you have a Medigap plan that covers Part B coinsurance.
Medicare Coverage for Allergy Shots (Immunotherapy)
For people with severe allergies that don't respond to other treatments, allergen immunotherapy (allergy shots) can help your body build immunity to specific allergens over time. Medicare Part B covers immunotherapy when:
Your doctor determines it's medically necessary
Previous treatments haven't controlled your symptoms
The treatment is administered in a medical facility equipped to handle allergic reactions
Your costs: Medicare pays 80% of the approved charges. You're responsible for 20% coinsurance after meeting your Part B deductible. A Medigap plan may cover your out-of-pocket costs.
Important: Medicare may stop covering allergy shots after approximately two years if your provider cannot demonstrate continued clinical improvement. Sublingual immunotherapy (drops or tablets under the tongue) is considered experimental by Medicare and is not covered.
Medicare Coverage for Allergy Medications
Medicare Part D: Covers prescription allergy medications, including nasal sprays, antihistamines, and inhalers prescribed by your doctor.
Over-the-counter medications: Generally not covered by Medicare. However, many effective allergy medications (like antihistamines) are available at low cost from wholesale retailers.
Medicare Advantage Coverage
Medicare Advantage (Part C) plans must cover at least the same allergy testing and treatment services as Original Medicare. Many plans offer additional benefits, such as lower copays for specialist visits or wellness programs. However, Medicare Advantage plans may require prior authorization for allergy treatments and have in-network requirements—be sure to see providers in your plan's network to avoid higher costs.
Most private health insurance plans—including ACA Marketplace plans and employer-sponsored coverage—cover allergy testing and treatment when medically necessary.
What's typically covered:
Allergy testing: Skin tests, blood tests, and food challenge testing are generally covered when ordered by a physician.
Immunotherapy (allergy shots): Most plans cover both the evaluation and treatment phases, including weekly or monthly visits that may span several years.
Prescription medications: Nasal sprays, antihistamines, and inhalers are typically covered under your plan's pharmacy benefits.
Specialist visits: Visits to allergists and immunologists are covered, though you may need a referral depending on your plan type (HMO vs. PPO).
Your costs depend on your plan:
Deductible: If you've already met your annual deductible, your out-of-pocket costs for allergy testing and treatment may be minimal.
Copays/coinsurance: You may owe a copay for office visits or a percentage of treatment costs after meeting your deductible.
Prior authorization: Some plans require prior approval for allergy testing or immunotherapy. Check with your insurer before starting treatment.
Timing tip: If you've already met your deductible for the year, it may be a good time to schedule allergy testing or start immunotherapy—your out-of-pocket costs will be lower. Remember that most deductibles reset on January 1.
ACA Marketplace Plans: Under the Affordable Care Act, health insurance plans cannot deny coverage or charge higher premiums because you have allergies or asthma (pre-existing conditions). ACA plans cover preventive care visits at no cost, which you can use to discuss allergy management with your doctor.
If you're affected by allergies, choosing the right health coverage can make a significant difference in managing your symptoms and costs. Our local North Carolina health insurance agents can help you:
Understand what your current plan covers for allergy testing and treatment
Find plans with good coverage for allergists and immunotherapy
Compare Medicare plans with allergy-related benefits
Review ACA Marketplace options during Open Enrollment
Choose a plan that fits your healthcare needs and budget