- Paying for Care
- Private Insurance
- Medicare and Medicaid
The majority of public and private health insurance plans cover genetic counseling, and if appropriate, genetic testing for people who have specific personal and/or family histories of cancer.
Genetic test results can affect your decisions about medical care. For example, genetic test results may influence treatment options or surgical recommendations if you are already diagnosed with conditions such as medication failure, cardiovascular diseases, diabetes/obesity, parkinson’s/alzheimer’s/dementia, or cancer. Genetic test results also inform you about your risk of other hereditary conditions as well. There are medical options if you have a hereditary genetic mutation that causes an increased risk of cancer.
If you are interested in genetic testing or if you think conditions such as medication failure, cardiovascular diseases, diabetes/obesity, parkinson’s/alzheimer’s/dementia, or cancer runs in your family, it is important to speak with your physician about your testing options with Genetics Institute of America (GIA). Oftentimes, your physician can and will advise you on the right genetic test that would best improve your plan of care.
Genetics Institute of America will verify your insurance coverage of the test and provide guidance if an insurance appeal and/or financial assistance is needed.
Most private health insurers cover genetic counseling and testing with little to no out-of-pocket costs for people who meet certain personal or family history criteria. Eligibility for genetic testing varies based on several factors, including:
- Your gender
- Type of health insurance
- Whether a previously-identified mutation exists in the family
- Personal history of conditions such as medication failure, cardiovascular diseases, diabetes/obesity, parkinson’s/alzheimer’s/dementia, or cancer
- Family history of cancer and/or diseases
- Which gene mutations are included in the GIAnomics™ tests
Under the Patient Protection and Affordable Care Act (ACA), genetic counseling and genetic testing for patients with specific personal and/or family history should be covered with no co-payment.
If you have any questions, please contact one of our specialized Care Coordinators for additional information about your eligibility for genetic testing.
Medicare and Medicaid cover genetic testing for some people. In this section, we provide information on coverage of genetic testing under current Medicare and Medicaid guidelines.
Medicare
Medicare covers genetic testing for people with active diagnoses and/or history of medication failure, cardiovascular diseases, diabetes/obesity, parkinson’s/alzheimer’s/dementia, or cancer who meet certain criteria. Our multigene panels is a type of genetic testing that looks for inherited mutations in more than one gene at the same time. It might include testing for BRCA1 and BRCA2 mutations in addition to mutations in other genes such as ATM, PALB2, CHEK2, etc. Medicare covers panel testing when:
- The genetic test will affect a patient’s treatment options
- All of the genes included in the test panel are relevant based on their personal and family history
- Patients with a personal history of cancers such as: ovarian, breast, pancreatic, prostate, intestine, brain, colon, bladder, thyroid, urinary, endocrine, melanoma, leukemia, and others
- Patients currently on medication for conditions such as: cardiac, mental health, and pain management
- Patients with a personal AND family history of cardiac conditions plus any relevant symptoms
- Patients with a personal AND family history of Type I or Type II Diabetes plus any relevant symptoms
Medicare coverage of multigene panel testing is available in all Medicare regions, although eligibility for this testing varies by Medicare Administrative Contractor (MAC).
Testing eligibility criteria differ by state. A qualified care coordinator will help you determine whether you meet Medicare and Medicaid guidelines for genetic testing coverage in your state.
Medicaid
All but two state Medicaid programs cover genetic counseling and testing for qualifying individuals with a personal history of medication failure, cardiovascular diseases, diabetes/obesity, parkinson’s/alzheimer’s/dementia, or cancer.