Is Genetic Testing for Cancer Covered by Insurance?

Many people find themselves asking, “Is genetic testing for cancer covered by insurance?” Unfortunately, the answer isn’t always straightforward. If you know some basic information, you can pursue some testing such as BRCA testing (covered by insurance in most cases). This kind of testing can help you estimate your chances of developing cancer, and it is available for specific types of cancer. It can be an invaluable resource regarding healthcare planning with your doctor.

What is Genetic Testing?

Genetic testing is a type of analysis that can detect changes in your chromosomes, proteins, or genes. Its use as a predictive or presymptomatic test can identify markers for the likelihood of developing certain types of cancer. 

Genetic testing, sometimes referred to as DNA testing, is not available for all types of cancer. However, if you have ever wondered, “Is cancer genetic testing covered by insurance?” the answer is that certain types of testing are covered.

BRCA Testing

Perhaps you have heard the acronym “BRCA” used to describe a particular type of genetic testing for mutations in breast cancer genes known as BRCA1 and BRCA2, which can significantly increase the risk of breast cancer. The mutation is found through a simple saliva test.

Is BRCA testing covered by insurance? Factors concerning BRCA testing, including cost and insurance coverage, can be difficult to navigate. If your healthcare provider recommends this type of testing, you’ll want to know not only is genetic testing for cancer covered by insurance but also, does insurance cover BRCA gene testing specifically? The ways you can cover this type of testing will be discussed later in this article.

Lynch Syndrome

Lynch Syndrome is a type of colorectal cancer, specifically hereditary non-polyposis colorectal cancer, and genetic testing is available for specific gene mutations such as MLH1. Not everyone with Lynch Syndrome will get cancer. Just like the question “does insurance cover BRCA testing?” many people also wonder whether this type of testing is also covered, and in some cases, it is.

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Does Insurance Cover Genetic Testing for Cancer?

There are different ways that insurance covers genetic testing for cancer. First, determine with your healthcare provider which type of testing you should get, and then explore what is covered by your particular insurance plan.

Private Insurance Companies

Generally speaking, federal law and most state laws do not require private insurance companies to cover predictive testing, which can include BRCA testing; insurance varies, however, as do the particular stipulations in each policy. For example, federal healthcare laws say that genetic testing should be covered for some women at higher risk of breast cancer.

Medicare

Does Medicare cover BRCA testing? There are limits to who is covered, but here is a list of some of the conditions that may allow you to access coverage:

  • A breast cancer diagnosis at age 45 or earlier
  • A close relative with a BRCA1 or BRCA2 gene mutation
  • Ethnicity with a higher rate of BRCA mutation frequency, such as Ashkenazi Jewish

 

ClarityX can help you determine whether your insurance covers the genetic cancer screening you need.

Does Medicare cover genetic testing for cancer more broadly? Medicare also covers Lynch Syndrome testing in limited cases. 

Who Should Have Genetic Testing

Genetic testing isn’t something that everyone needs or should have. In general, this type of testing is aimed at individuals with a particular family or personal history of cancer. This is why, in addition to finding out is genetic testing for cancer covered by insurance, you should discuss with ClarityX whether you are a good candidate for these exams. 

Cancer Info Graph

Costs of Genetic Testing

If your insurance coverage doesn’t pay for genetic testing, what kind of costs are involved? The answer can vary because some laboratories may offer free or low-cost testing if you meet certain criteria, while private testing can also run from several hundred dollars to several thousand depending on the number of mutations you wish to be tested. Keep in mind that even if insurance doesn’t cover the cost of genetic testing, ClarityX has options to help you get a cancer screening. 

Taking the Next Step With Genetic Testing

Screening for hereditary cancer is a powerful tool, especially if you have a personal or family history of certain types of cancers such as breast cancer or colorectal cancer. The good news is that this type of testing is readily available for people who could benefit from it. ClarityX is a trusted source for precision medicine, offering genetic testing for cancer screening. 

Contact ClarityX if you would like to learn more about how you may benefit from understanding the potential risks you may face in terms of developing cancer and how this testing can positively impact your treatment by allowing you to predict and prevent cancer before symptoms occur.

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