Genetic testing for inherited mutations

Insurance coverage for genetic counseling and testing

Most health plans cover genetic counseling and testing for inherited gene mutations linked to cancer in people who meet the national guidelines. The cost of testing and your out-of-pocket charges may vary based on several factors.

People who are denied coverage for genetic testing can file an appeal (FORCE has sample appeal letters). Your healthcare provider can work with your insurance company and help you file an appeal if needed. Low cost testing may be available for $250 or less. Learn more about coverage for genetic counseling and testing here. 

BRCA testing under the Affordable Care Act

Under the Affordable Care Act (ACA), insurance companies must pay for both genetic counseling and BRCA testing with no out-of-pocket costs for women who meet certain criteria. The ACA regulations are limited to testing for BRCA1 and BRCA2 only and do not cover genetic counseling or testing in all situations. You can learn more about BRCA testing under the ACA here. 

Medicare and Medicaid coverage of genetic testing

Genetic counseling and testing is typically covered by Medicare for people already diagnosed with cancer who are in treatment or for whom test results may affect their care. Most state Medicaid programs cover genetic testing for BRCA and Lynch Syndrome mutations for people who meet requirements, which vary by state. You can read more about Medicare and Medicaid coverage of genetic testing here.

Financial assistance or low cost genetic testing

JScreen is a national program based out of Emory University that provides low-cost at-home genetic counseling and testing with financial assistance available. Many laboratories offer low-cost genetic testing or financial assistance programs. Programs vary, so if you are not eligible for assistance through one lab, consider contacting other labs to see if you qualify .   

• Ambry Billing and Insurance
• Color for All (Color's Family Testing Program offers $50 testing for relatives of people with a known mutation)
• Invitae Patient Assistance Program
• Quest Financial Assistance Program
• Natera Compassionate Care Program
• Myriad Cares
• Sema4 Financial Assistance 

updated: 02/15/2022