Genetic, or DNA testing, is a form of medical testing that physicians may order for patients so they can identify genetic changes in chromosomes, genes, or proteins. These tests may confirm, or rule out, genetic mutations that are known to be responsible for certain illnesses and other health conditions.
The three main types of genetic testing are the chromosome study, DNA study, and biochemical genetic study. If you have one of these tests run, a technician first takes a sample of your blood, hair, skin or other tissue, such as a swab from the inside of your cheek. The sample is then sent to a laboratory that does genetic testing.
Among the most common genetic mutations tested for these days are the BRCA mutations. BRCA is the abbreviation used for the breast cancer susceptibility gene. Women who have either the BRCA1 or BRCA2 mutation, have a five times higher risk of getting breast cancer, and an even higher risk of getting ovarian cancer in comparison to women who do not have the BRCA mutations.
Your health care provider may suggest genetic testing to diagnose or find the cause of a disease, to find the best treatment option for a disease, or to determine your risk for a preventable disease to begin treatment before its onset. If you know that you are at risk for an inherited disease like breast cancer, you may want to ask your doctor to order genetic testing.
Medicare Benefits for Genetic Testing for Breast Cancer
Although Original Medicare does not offer coverage for most genetic testing, testing for the BRCA mutations is an exception in some circumstances. If you have a family or personal history of breast or ovarian cancer, your Original Medicare Part B (medical insurance), or Medicare Advantage (Part C) policy may cover your genetic testing if you also meet at least one of the following requirements:
• You were diagnosed with breast cancer at age 45 or earlier.
• You have had two primary breast cancers before the age of 50.
• You have a history of epithelial ovarian, fallopian tube, or primary peritoneal cancer.
• Your ethnicity has a higher rate of BRCA mutation frequency, Ashkenazi Jewish for example.
• You have a close relative with a BRCA (1 or 2) mutation.
• You have a close male blood relative diagnosed with breast cancer.
In addition to the requirements stated above, your health care provider must certify that by undergoing genetic testing for the BRCA mutations to determine your risk for developing breast or ovarian cancer, you have definite medical benefits.
The genetic testing must be ordered by a health care provider who accepts Medicare assignment, and the laboratory doing the testing must also be Medicare approved.
The Cost Benefits of Genetic Testing with Medicare Benefits
If you meet the criteria for genetic testing, Medicare Part B pays for 80 percent of the Medicare-approved cost of the testing. You are responsible for the remaining 20 percent and the Part B deductible which is $185.00 in 2019.
If you have a Medicare Advantage (Part C) policy, how much you pay out-of-pocket depends on your policy. You may have a copayment or coinsurance fee, or you may have a plan with a deductible. By working together with your insurance provider and the laboratory doing the testing, you can determine beforehand what your final costs are. In many cases, Medicare Advantage policies cover 100 percent of the genetic testing costs.
For people who do not have Medicare coverage, the cost of genetic testing for the BRCA mutations is approximately $250.00 depending on the laboratory. There are also many laboratories in the United States that offer free testing for BRCA.
Thanks to genetic testing for the BRCA gene mutations, women are able to take measures to reduce their risk for cancer if they test positive for BRCA1 or BRCA2. If you have concerns about genetic testing for breast or ovarian cancer, and whether you have health insurance coverage for testing, discuss your concerns with your doctor and check with your plan directly for detailed coverage information.