Does Medicare Cover Genetic Testing?
- The answer to the question does Medicare cover genetic testing is complex. Find out more about what might be covered and when if you have a Medicare plan.
Medicare does pay for some genetic testing. However, it rarely pays for genetic screening tests and does not pay for tests that help you find out about your ancestors or whether an ingredient like cilantro might not be ideal for you given your genetics.
Genetic testing covers a wide number of tests.
You have tests that help you find out what your heritage is or whether you're genetically predisposed to something like a food allergy or even cancer. There are also genetic tests that can be used for diagnostic purposes to help doctors know what the best treatment might be for certain conditions.
When Does Medicare Pay for Genetic Testing?
Medicare Part B covers one genetic test for screening purposes: a screening test to look for colorectal cancer. This test is covered once every three years for people with an average risk of developing colorectal cancer and no symptoms. A doctor must order this test.
Medicare also covers multi-target stool DNA tests.
Most of the other genetic tests covered by Medicare are designed to help providers best treat patients who have a cancer diagnosis. Coverage varies based on where you live because Medicare is administered at a regional level. It also may depend on whether you opted for Original Medicare (Parts A and B) or a Medicare Advantage (Medicare Part C) plan.
Medicare Advantage plans must cover all of the same benefits as Original Medicare, but some plans might also provide additional coverage.
What Genetic Testing Does Medicare Cover for Cancer Patients?
Testing may be covered for patients with a variety of conditions, including:
- Certain types of prostate cancer
- Certain types of breast cancer in males or females
- Any cancer that is associated with a BRCA mutation if there is a history of that mutation in the family
Medicare also requires that patients undergo counseling with a genetics professional that is a third party (i.e., not associated with any lab doing the testing) and that the testing will have an impact on the patient's cancer treatment.
