Does Medicare Cover Genetic Testing?

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 include an annual out-of-pocket spending limit for Part A and Part B services, which is not offered by Original Medicare (Part A and Part B).

What genetic tests are covered by Medicare?

Original Medicare typically does not cover preventative genetic tests.

Medicare Part B medical insurance may cover genetic testing in the following situations:

• You have signs or symptoms that may be able to be diagnosed with a genetic test
  
  
• Your metabolism of certain drugs needs to be assessed
  
  
• You have a personal history of breast cancer (or BRCA1 and BRCA2, two genetic indicators of breast cancer) and meet other specific criteria
  
  
• You have a history of epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer

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.

How much do genetic tests cost with Medicare?

If Medicare covers your genetic testing, there are some out-of-pocket costs you should expect to pay, which may include:

• Part B deductible
• Part B coinsurance or copayment

Medicare Part B deductible and genetic tests

For all beneficiaries, the Medicare Part B deductible is $226 per year in 2023.

Medicare Part B coinsurance or copayment

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 may offer other benefits

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.

Medicare Advantage plans may also offer other benefits not found in Original Medicare.  

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.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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