How BRCA Testing Works
Testing requires a blood or saliva sample sent to a lab. Results take 2–4 weeks and fall into one of three categories:
Positive
A harmful mutation was found. Your care team will build a risk management plan.
Negative
No known harmful mutation found. Enhanced screening may still be recommended if family history is strong.
VUS
Variant of uncertain significance. A change was found, but its impact is not yet known. Monitoring continues.
Who Qualifies? The USPSTF Criteria
The U.S. Preventive Services Task Force (USPSTF) sets the criteria that trigger zero-cost ACA coverage. It's a two-step process:
Step 1: Do You Meet at Least One of These?
Personal History
You have had breast, ovarian, tubal, or peritoneal cancer (including if cancer-free after treatment).
Family History
Relatives on either side of the family with breast, ovarian, tubal, or peritoneal cancer.
Ancestry
Ashkenazi Jewish or other ancestry associated with elevated BRCA mutation rates.
Meeting any one of these qualifies you for a formal risk assessment using a validated screening tool. This is a Grade B recommendation, meaning the ACA requires non-grandfathered plans to cover both the counseling and testing at $0.
Step 2: What the Screening Tools Look For
Your clinician uses a validated tool (not just an informal conversation) to score your risk. These tools evaluate:
Age at Diagnosis
Breast cancer before age 50
Bilateral Cancer
Cancer in both breasts
Male Breast Cancer
Any male relative with breast cancer
Multiple Cases
Several family members affected
Two Cancer Types
One person with two BRCA-related cancers
Ancestry
Ashkenazi Jewish or other high-risk heritage
View all USPSTF-validated screening tools
| Tool | Notes |
|---|---|
| Ontario Family History Assessment Tool | Widely validated across multiple studies |
| Manchester Scoring System | Points-based, accounting for cancer type and age |
| Referral Screening Tool (B-RST) | Among the simplest; available at breastcancergenescreen.org |
| Pedigree Assessment Tool | Assigns points per affected family member; quick |
| 7-Question Family History Tool | Brief questionnaire format |
| Tyrer-Cuzick (IBIS) | International Breast Cancer Intervention Study |
| BRCAPRO (brief versions) | Statistical model estimating mutation probability |
Note: General breast cancer risk tools (like the Gail model) are not appropriate here. Those estimate overall risk, not the likelihood of a specific genetic mutation.
The Testing Process
Here's how it works from start to finish:
Assess Your Risk
Review personal and family cancer history. Look for early-onset breast cancer, ovarian cancer, pancreatic cancer, male breast cancer, or high-risk ancestry.
Talk to a Provider
Discuss your history with your primary care provider, OB/GYN, or oncologist. They can refer you to a genetic counselor. Or call FORCE at 866-288-RISK, ext. 704 for a free referral.
Genetic Counseling
A counselor reviews your risk in depth, explains testing, discusses what results could mean, and helps navigate insurance. Some insurers require this step before covering the test.
Verify Insurance Coverage
Call your insurer before testing. If you meet USPSTF criteria with a non-grandfathered ACA plan, your cost should be $0. See the Insurance & Aid page if coverage is denied or you're uninsured.
Get Tested
A simple blood draw or saliva sample. Results arrive in 2–4 weeks.
Review Results
Go over results with your genetic counselor, whether positive, negative, or VUS. A positive result leads to a personalized risk management plan.
Family Cascade Testing
If a mutation is found, first-degree relatives should be offered testing. Testing for a known mutation is simpler and less expensive than the initial test.
Gaps in the Current Criteria
Men Excluded
USPSTF covers women only. Many insurers still cover men under standard medical necessity, but it's not guaranteed.
Unknown Family History
No guidance for adopted individuals, small families, or those estranged from biological relatives.
BRCA Only
Other cancer genes (ATM, CHEK2, PALB2, Lynch) are not covered under this recommendation.
Under Revision
The USPSTF began updating the 2019 criteria in January 2025. Changes may broaden eligibility.
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