Finding Health Care
Financial help
Overview
The cost of genetic testing ranges from several hundred to several thousand dollars. Costs vary according to factors including:
- whether a previously-identified mutation exists in the family
- whether the family's ancestry suggests the possibility of a particular mutation (for instance Jewish founder mutations or Polish founder mutations)
- which hereditary predisposition is being tested for
- whether an expedited test (with results in 7-10 days) has been ordered
Most insurance companies will cover the cost of genetic testing in individuals who have either a personal history or family history of cancer and who meet certain guidelines.
Financial assistance for diagnosis or treatment of cancer is sometimes available. Fewer resources are available for those seeking assistance with the cost of genetic counseling or testing, or preventive options such as chemoprevention or prophylactic surgery. Preventive medicine is sometimes considered elective and, therefore, not always covered by assistance programs. Requesting help from a health care professional who is knowledgeable in genetics ensures that the genetic test ordered for you is appropriate. A genetics counselor or expert can also help you request medical reimbursement for testing.
Medicare coverage of genetic testing
Under Medicare's new guidelines, BRCA1 and BRCA2 genetic testing is covered for people with:
- Personal history of breast cancer + one or more of the following:
- Diagnosed age ≤45 y, with or without family history
- Diagnosed age ≤50 y or two breast primaries, with ≥1 close blood relative(s) with breast cancer ≤50 y or ≥1 close blood relative(s) with ovarian cancer /fallopian tube/primary peritoneal cancer
- Two breast primaries when first breast cancer diagnosis occurred prior to age 50
- Diagnosed at any age, with ≥2 close blood relatives with breast and/or epithelial ovarian/fallopian tube/primary peritoneal cancer, at any age
- Close male blood relative with breast cancer
- Personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer
- If of certain ethnicity associated with higher mutation frequency, (eg, founder populations of Ashkenazi Jewish, Icelandic, Swedish, Hungarian or other) no additional family history required
- a close relative with a known BRCA1 or BRCA2 gene mutation
2. Personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer + one or more of the following:
- ≥1 close blood relative(s) with ovarian cancer
- ≥1 close female blood relative(s) with breast cancer at age ≤50 y or two breast primary cancers
- ≥2 close blood relatives with breast cancer
- ≥1 close male blood relative(s) with breast cancer
- If of Ashkenazi Jewish descent, no additional family history is required
- a first or second-degree relative with a known BRCA1 or BRCA2 gene mutation
3. Personal history of male breast cancer if one or more of the following is present:
- ≥ 1close male blood relative(s) with breast cancer
- ≥1 close female blood relative(s) with breast or ovarian cancer
- If of certain ethnic descent associated with deleterious mutations (eg, founder populations of Ashkenazi Jewish), no additional family history is required
- a first or second-degree relative with a known BRCA1 or BRCA2 gene mutation
Insurance coverage of genetic testing
Most health insurance companies will pay for genetic testing if a person meets particular criteria indicating that hereditary cancer might run in the family. Myriad Genetics, the company that performs genetic testing, has an insurance reimbursement assistance program which facilitates insurance coverage of genetic testing by obtaining preauthorization.
Medicaid coverage of genetic testing
17 State Medicaid programs currently cover BRACAnalysis® for qualifying individuals. State requirements vary. A qualified genetics expert can help determine if you meet state Medicaid guidelines for genetic testing coverage. The states that offer Medicaid coverage include:
Alaska
Arizona
Colorado
Connecticut
Illinois
Indiana
Iowa
Missouri
New Jersey
New York
New Mexico
Ohio
Oregon
Texas
Utah
Virginia
Washington
Financial assistance for genetic testing
A genetic counselor can help determine if you qualify for a financial assistance program to cover the cost of genetic testing. For more information on genetic counseling and how to find a genetic counselor see our section on this topic.
Some affiliates of the Susan G. Komen Breast Cancer Foundation fund local programs which provide genetic testing to uninsured or underinsured people. You can look up affiliates by state through this link.
Genetic testing within research
Some limited research studies cover the cost for genetic testing as part of the study.
Creighton University offers genetic testing on a research basis at no charge to patients who are qualified/ approved by their collaborating geneticist. Contact the study coordinator to see if you qualify for Creighton's testing program.
Financial assistance for medical care
Public assistance, such as Medicaid may be available if you are ineligible for other programs. The Centers for Medicare and Medicaid Services website has a link to state Medicaid programs. There are specific criteria for Medicaid eligibility.
Most hospitals have social workers or financial assistance counselors who can help explain your options and direct you to resources which provide assistance in paying for medical care. Some hospitals designated as Hill-Burton facilities receive money from the federal government. These hospitals must provide a certain amount of free or reduced-cost health services every year to those who cannot pay. Each facility may decide which type of free or reduced-cost care it will provide, and must publish this information in the newspaper, as well as provide a written notice to you upon request for Hill-Burton Assistance.
Local chapters of organizations sometimes offer free screening or financial assistance for medical screening.
Other websites
Free genetic testing research study through Creighton University.
Genetic testing research study for African-American premenopausal women with
breast cancer
Provides free genetic testing for those who qualify.
Medicaid site for consumer information
Medicare coverage criteria for genetic testing
Myriad reimbursement assistance program
National Coalition of Cancer Survivorship
Includes a page on finding financial help for cancer treatment.
The Lynne Cohen
Cancer Screening & Prevention Project for High Risk Women Bellevue Hospital
Center/NYU Cancer Institute
This program makes a special
effort to provide excellent medical care to uninsured, underserved minority
women from communities that have traditionally had fewer medical services
available.