Coverage at a Glance
Your path to testing depends on your insurance type. Here's the landscape:
✅ Private Insurance (ACA Plans)
If you meet the USPSTF high-risk criteria, non-grandfathered ACA plans must cover counseling and testing with in-network providers.
⚠️ Medicare
Covers testing only for individuals with a personal cancer diagnosis meeting specific criteria. Does not cover family-history-only testing.
🌐 Medicaid
Coverage varies significantly by state. Every state except Alabama covers qualifying individuals. ACA expansion enrollees have stronger protections.
Affordable Care Act (ACA) Details
✅ What the ACA Covers
BRCA1/2 counseling and testing for women meeting USPSTF criteria, at in-network providers, with no copay, deductible, or coinsurance.
❌ What the ACA Does Not Cover
Testing for men. Genes other than BRCA1/2 (ATM, CHEK2, PALB2). Medicare and Medicaid (separate rules). Grandfathered plans. Women currently in active cancer treatment (though most insurers cover this anyway).
Medicare Criteria
Medicare covers BRCA testing when the individual has a personal cancer history and meets one of these:
Age ≤ 45
Breast cancer diagnosed at or before age 45
Triple-Negative
TNBC diagnosed at or before age 60
Ashkenazi + Cancer
Ashkenazi Jewish heritage with breast cancer
Related Cancer
Personal history of another suspected BRCA-related cancer
Key limitation: Medicare does not cover testing for individuals with a family history of cancer but no personal diagnosis. Coverage criteria can also vary by regional Medicare Administrative Contractor (MAC).
Lab Financial Assistance Programs
If you're uninsured, underinsured, or denied coverage, major labs offer assistance that can reduce or eliminate costs:
| Lab | Key Benefits | Max Cost | Contact |
|---|---|---|---|
| Myriad Genetics | Free for uninsured at ≤400% poverty level. Interest-free plans at $15/mo. | $0–$295 | myriad.com 800-469-7423 |
| Quest Diagnostics | $0 at poverty level. Will notify you if cost exceeds $100 before testing. | $0–$200 | questdiagnostics.com |
| Labcorp / Invitae | Income-based assistance. Proactive contact if cost exceeds $100. | Varies | invitae.com 833-941-0828 |
| Ambry Genetics | Financial assistance programs available. | Varies | ambrygen.com |
| Color Genomics | Lower-cost options. Free testing for ovarian cancer risk through OCRA partnership. | ~$200–300 | color.com |
Direct-to-Consumer Testing
Medical-grade tests via mailed saliva kits, typically $200–300. A physician is involved and a genetic counselor reviews positive results.
JScreen
Set fee includes kit + genetic counselor consultation. Cost stays predictable even if insurance denies.
Color Genomics
Affordable panel testing. Free testing for ovarian cancer risk through OCRA partnership.
Ancestry kits are not a substitute. Companies like 23andMe check only a small number of BRCA mutations. They are recreational, not medical-grade, and should not guide healthcare decisions.
Additional Assistance Resources
CDC NBCCEDP
Free/low-cost breast and cervical cancer screening for uninsured women ages 40–64 (breast) and 21–64 (cervical). Income: ≤250% of federal poverty level.
Find a program → | Phone: 1-800-232-4636Co-Pay Relief (copays.org)
Co-pay, co-insurance, and deductible relief for cancer genetic testing. Fund availability varies; sign up for alerts.
copays.org →American Breast Cancer Foundation
Screening aid for uninsured and underserved individuals, regardless of age or gender.
abcf.org →Patient Advocate Foundation
Case managers help identify financial assistance programs for healthcare cost challenges.
patientadvocate.org →Hospital Charity Funds & Research Studies
Many testing centers have charity funds for case-by-case relief. Some research studies offer free testing to participants. Ask your genetic counselor.
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