Medicare may cover genetic testing when it is ordered by a doctor, but only for specific types of cancer, and only if you meet certain criteria.
Medicare Advantage (Part C) plans may also cover medically necessary genetic tests in very limited circumstances for certain types of cancer.
Many Medicare Advantage plans cover prescription drugs and offer annual out-of-pocket spending limits for Part A and Part B services, both of which are not offered by Original Medicare (Part A and Part B).
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Original Medicare typically does not cover preventative genetic tests.
Medicare Part B medical insurance may cover genetic testing in the following situations:
Medicare Part B may also cover a screening test for colorectal cancer once every 3 years.
If your genetic test is not covered by Medicare, you may be responsible for 100 percent of the cost.
If Medicare covers your genetic testing, there are some out-of-pocket costs you should expect to pay, which may include:
For all beneficiaries, the Medicare Part B deductible is $198 per year in 2020.
When you reach your Part B deductible, you will typically pay 20 percent of the Medicare-approved amount for most doctor’s services.
Talk to your doctor for specific cost and coverage information.
Medicare Advantage plans are sold by private insurance companies and are an alternative to Original Medicare. Medicare Advantage plans cover the same benefits that are covered by Original Medicare.
If your genetic test is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.
A licensed insurance agent can help you compare available Medicare Advantage plans in your area. Call to speak with an agent today to learn if you’re eligible to enroll and find a plan that fits your needs.
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Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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