Does Medicare Cover BRCA1 And BRCA2 Testing?

Genetic testing is a form of medical testing that identifies genetic changes in the patient’s chromosome, genes, or proteins. This kind of testing can detect cancer, such as with the BRCA1 and BRCA2 genetic tests. Both BRCA1 and BRCA2 genetic tests are used to determine a woman’s risk of developing breast and ovarian cancer.

For those who want to get this testing done, a common question many have is, “does Medicare cover BRCA1 and BRCA2 Testing?” In this article, we answer that question in clear, plain English. You will also find the average costs of BRCA1 and BRCA2 genetic tests and other helpful info.

Does Medicare Cover BRCA1 And BRCA2 Testing?

The short answer is yes. Medicare will cover the cost of BRCA1 and BRCA2 genetic tests. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your BRCA1 and BRCA2 genetic tests. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for BRCA1 and BRCA2 genetic tests. Even though Original Medicare does not often provide coverage for genetic testing, they cover BRCA1 and BRCA2 genetic tests.

Original Medicare provides coverage for BRCA1 and BRCA2 genetic tests if it is considered medically necessary by your healthcare provider. Your healthcare provider must make sure that you will have medical benefits by undergoing BRCA1 and/or BRCA2 genetic tests.

Coverage for BRCA1 and BRCA2 genetic tests is provided by Medicare Part B. For Medicare Part B to provide coverage, your healthcare provider and the test lab where the test will take place must be Medicare-approved. Aside from those two requirements, Medicare Part B will provide coverage if you:

Recieved a breast cancer diagnosis at 45 years of age or younger
Have two primary breast cancers before reaching the age of 50
Have a history of the epithelial ovarian, fallopian tube, or primary peritoneal cancer
Ethnicity has a higher rate of developing BRCA mutation
Have a relative that has BRCA1 or BRCA2 mutation
Have a male relative with a breast cancer diagnosis

Once approved, Medicare Part B will cover 80 percent of the costs of your BRCA1 and/or BRCA2 genetic tests. You will pay for the remaining 20 percent as a copayment.

Part C Coverage for BRCA1 and BRCA2 Testing

Medicare Advantage plans (Medicare Part C) also provide coverage for BRCA1 and BRCA2 genetic tests. Advantage plans, by law, have to cover everything that Original Medicare covers. The Advantage plans will also offer additional benefits for their members.

Most Medicare Part C plans cover 100 percent of the costs of genetic testing such as BRCA1 and BRCA2 genetic tests.

How Much Do BRCA1 And BRCA2 Genetic Tests Cost?

The costs of BRCA1 and BRCA2 genetic tests can range from $300 to over $5,000. This cost will vary depending on the provider.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.