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 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).
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 $198 per year in 2020.
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 additional 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.
Many Medicare Advantage plans may offer prescription drug coverage. Some plans may also offer coverage for routine dental, hearing and vision care, as well as some other benefits.
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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