Medicare offers seniors many great benefits, including the ability to partially or fully subsidize medical procedures and treatments.

Genetic testing is one of the types of preventative treatments that Medicare has subsidized in recent years, as long as it falls within specific parameters.

2022 Guidelines For Medicare and Genetic Testing

In 2022, now it is very clear what Medicare will subsidize and what they will not cover. 

  • The genetic test must be ordered by a doctor or ‘counselor’ who does not work for the laboratory that handles the DNA testing
  • In most cases the genetic test beneficiary must directly have a history of disease, symptoms of the disease or a family history of the disease in for which the test is performed
  • Some states are wholly exempt from providing coverage for some tests. For example, Medicare in the state of New York does not provide reimbursements for any genetic tests

The stipulations to receive 100% subsidized coverage by Medicare may vary from state to state and it’s always important to confirm the requirements in your state.

While genetic tests for cancer can have more stringent requirements to be subsidized other tests like diabetes have much more lenient guidelines. In the case of a diabetes genetic test, seniors enrolled in both Medicare Part A and Part B will fully cover the costs if your doctor believes you may be at risk of developing diabetes and in this situation it does not require a prior family history of the disease. 

Most Common Genetic Test Covered by Medicare

At this time some of the most common test that Medicare can 100% fully subsidize would include but are not limited to:

  • Heart Disease
  • Diabetes
  • Cancer
  • Pharmacogenomic (Medication Prescriptions)

Warning For Seniors Against FREE Test Scams

Recently the Administration for Community Living has issued warnings to seniors against anyone offering free genetic testing as this may not always be factual.

In situations where you are offered a free genetic test the Administry for Community Living has made recommendations on how to handle these situations:

  1. Always review your Medicare Summary Notice to confirm your eligibility of benefits.
  2. If you are offered genetic testing services from someone at a public event like a local fair, farmer’s market or other larger event do not accept it.
  3. If you receive a genetic testing kit that was not ordered by your physician and confirmed, do not accept it and return it to sender.
  4. When asked to provide personal information over the phone or via any communication channel, always be cautious, including your Medicare number.

While there are a large variety of available tests, it’s important to confirm your Medicare benefits and confirm everything mentioned above or you could be billed several thousand dollars if Medicare will not subsidize it.

While Medicare may not always cover genetic tests, due to the fact that this preventative test helps stave off future medical costs, more insurances are accepting these tests.

For example the ASCO (American Society of Clinical Oncology), has strongly lobbied insurance providers across the country to accept these tests for cancer prevention. As of 2022, of the 31 billing codes they list related to these genetic test almost half clearly indicate this is a ‘preventative’ or ‘risk reduction’ treatment.

While it’s clear that Medicare is limited in its ability to cover these tests, especially in the area of oncology, there are many other tests of benefit to Seniors.

From the FTC Fact Sheet on Genetic Testing

Link To The FTC Fact Sheet

These are two important facts to keep in mind reported by the FDA regarding at-home consumer genetic testing:

Validity of Genetic Tests According To The FDA And CDC

According to the Food and Drug Administration (FDA), which regulates the manufacturers of genetic tests; and the Centers for Disease Control and Prevention (CDC), which promotes health and quality of life, some of these tests lack scientific validity, and others provide medical results that are meaningful only in the context of a full medical evaluation.

Claims Of Genetic Tests
Having a particular gene doesn’t necessarily mean that a disease will develop; not having a particular gene doesn’t necessarily mean that the disease will not.