Most private insurers cover genetic testing for inherited mutations

Most private health insurers cover genetic counseling and testing with low- or no out-of-pocket costs for people who meet certain personal or family cancer history criteria. The cost of genetic counseling and testing varies based on several factors, including:

• Your gender
• Type of health insurance
• Which laboratory performs the test
• Whether a previously-identified mutation exists in the family
• Which gene mutations are included in the test

Under the Patient Protection and Affordable Care Act (ACA), genetic counseling and BRCA testing for women with specific personal and/or family cancer history should be covered with no co-payment. Coverage at 100% applies to in-network health care providers only. Services provided by out-of-network providers could result in out-of-pocket costs.

BRCA genetic testing for men—and women who are currently being treated for cancer—is not covered under the ACA preventive services, but most private health insurers will cover testing for those who meet specific personal and/or family cancer history criteria. Deductibles, coinsurance and copays usually apply. 

Genetic testing for mutations other than BRCA1 and BRCA2 not covered under the ACA. Most health insurers cover testing for other genetic mutations (i.e. ATM, CHEK2, PALB2, Lynch Syndrome, etc.) but deductibles, coinsurance and copays will likely apply. 

Medicare, Medicaid, self-funded and short-term health plans are not required to abide by all of the ACA rules and may have different policies regarding coverage of genetic services.