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BRCA genetic counseling and testing for women

Under the Patient Protection and Affordable Care Act (ACA), most health insurers are required to Woman getting a blood testpay for BRCA genetic counseling and testing for women who meet certain personal and/or family history criteria. If you meet the testing requirements, insurance companies must cover the entire cost of genetic counseling and BRCA testing with no out-of-pocket costs to you. 

The ACA does not require coverage of genetic counseling and testing for people who do not meet the U.S. Preventive Services Task Force (USPSTF) guidelines, including:

  • Genetic counseling or testing for people with a family history that suggests Lynch Syndrome (associated with colon, uterine and ovarian cancer) or other hereditary cancer syndromes
  • Genetic testing for genes other than BRCA1 and BRCA2 (i.e., ATM, CHEK2, PALB2, etc.)
  • Genetic counseling and testing for men

Most private group and individual health insurers cover genetic testing for people who don't meet the USPSTF BRCA testing criteria but deductions, consinsurance and copays typically apply. 

Note that the ACA does not apply to Medicare or Medicaid. They have their own rules. See the Insurance and Paying for Care section of our website to learn more.

Filing a genetic testing lab complaint

CLIA

All clinical laboratory testing performed on humans in the U.S. (except in clinical trials and basic research) is overseen by the Clinical Laboratory Improvement Amendments (CLIA).

If you have concerns or want to file a complaint against a lab that conducted genetic testing, you or your health care provider should reach out to your state CLIA contact

All other questions or concerns about the CLIA program should be submitted to LabExcellence@cms.hhs.gov.

FDA

The Food and Drug Administration (FDA) also tracks adverse (negative) events and concerns about laboratory tests through MedWatch: The FDA Safety Information and Adverse Event Reporting Program. Patients or health care providers can report adverse events to the FDA.

finding-experts
  • Visit the How to Get Testing section of our website for criteria for genetic testing and information on finding a cancer genetics expert.
  • FORCE's toll-free helpline: 866-288-RISK, ext. 704, can connect you with a volunteer board-certified genetic counselor who can answer general questions about genetic testing and hereditary cancer and help you find a genetic counselor near you. 
  • FORCE Peer Navigator Program will match you with a volunteer who has undergone genetic counseling and can help you navigate resources to find a genetic counselor near you.
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