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Paying for Genetic Services

Locate medical experts and find information on insurance coverage and financial assistance for risk management, treatment and follow up care.

Insurance coverage of genetic services

Most health insurance companies will cover the cost for genetic counseling and genetic testing if a person meets particular criteria indicating that hereditary cancer might run in the family. A genetic counselor can determine if your insurance will cover genetic testing and help the process go smoothly.  

Under the Affordable Care Act, insurance companies are required to pay for both genetic counseling and BRCA testing for women who meet certain criteria. For these patients, insurance companies must cover the entire cost of genetic counseling and BRCA testing with no out-of-pocket costs to the individual. 

The Affordable Care Act regulations do not cover the following situations:

  • genetic counseling and testing in people who do not meet United States Preventive Services Task Force (USPSTF) guidelines
  • genetic counseling or testing in people with a family history indicative of Lynch Syndrome (associated with colon, uterine, and ovarian cancer) or other hereditary cancer syndromes
  • genetic counseling and testing in men
  • panel testing or testing for genes outside of BRCA1 and BRCA2
  • risk-management services such as increased surveillance and prophylactic surgery 

Even in situations that are not covered under the Affordable Care Act, health insurance often covers the costs of genetic counseling and testing. A genetics expert can work with your insurance company to assure that you receive the services you need while minimizing the costs to you, and to help you appeal if your insurance company denies these services. Further information on insurance appeals is available on our Health Insurance Appeals page. Financial assistance is often available for those who require it.

 

Updated 12/23/16

FORCE:Facing Our Risk of Cancer Empowered