Genetic counseling can play an important role in evaluating your chance of developing certain diseases or in preparation for pregnancy. Understanding what your risk is for developing cardiovascular disease, psychiatric disorders, or certain cancers can help you take important preventive steps to lower your risk. Genetic counseling before pregnancy can help determine whether you have any genetic conditions that may affect your unborn child or their health once they are born.

Medicare provides coverage for many medical services and supplies for seniors and individuals under the age of 65 with certain disabilities. Part A (Hospital Insurance), Part B (Medical Insurance), and Part D prescription drug coverage can help lower your out-of-pocket expenses for medical care under specific circumstances. As genetic testing and counseling become more prevalent, you may be wondering if your care would fall under any of the Medicare categories of coverage.

Does Medicare Cover Genetic Counseling?
Medicare will Parts A and B may cover genetic counseling when the procedure is undertaken as the result of a medical necessity in a skilled nursing facility or when counseling has been ordered by a Medicare-approved physician prior to starting a medication that may be covered under Part D. Counseling may also be covered as part of a temporary stay at a skilled nursing facility or hospital under Medicare Part A.

Legislative Efforts For Greater Access to Genetic Counseling
Although genetic counseling may be covered by Medicare when ordered by a physician, genetic counselor services are not generally covered independently. This means that you can’t simply seek out a genetic counselor on your own and have the service covered by Medicare because you will need to have the testing completed under your doctor’s orders. On top of that, genetic counseling is still considered to be an advanced procedure in many parts of the country and is only available to individuals residing in areas with access to newer medical technologies. Although the spread of genetic counseling is growing rapidly, the stipulations and limited access mean that not everyone can take part in important genetic tests to catch diseases early.

Legislation has been considered to remove the roadblocks that may keep people from easily accessing genetic counseling. Legislative bills that provide for changes to existing Medicare guidelines have been introduced. If you are unable to access genetic counseling under your current Medicare benefits, you may be able to in the future. If you’re concerned about a predisposition to developing conditions like cancer, muscular dystrophy, or Huntington’s disease, talk to your doctor to discuss your options.

Discuss Your Concerns With Your Doctor
If you’re receiving Medicare and you’re concerned about your risk for the development of a disease as the result of a genetic predisposition, now is also the time to speak with your doctor. He or she will be able to provide you with information regarding your current and potential treatment options, and if need be, genetic counseling may be ordered and covered by Medicare.

Additionally, some Medicare Advantage plans may include additional benefits to help alleviate out-of-pocket costs for genetic counseling in the event that you aren’t eligible for direct coverage through Medicare Part A or Part B. You may also be able to receive financial assistance from various foundations that promote the use of and access to genetic counseling across the country.

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