I'm considering genetic testing to assess my cancer risk based on family history. Will Medicare cover this preventive approach in my situation?

Question

Larry Dalton · Accepted Answer

Under traditional Medicare Part A and B with a Medigap plan, Medicare generally does not cover pre-symptomatic genetic testing for cancer risk assessment.  However, with a doctor's order for the testing, it will most likely be approved for certain types of cancer testing.  Some Medigap plans come with a rider that covers 100 percent of preventive care testing.   

Under the Medicare Advantage plan, these tests most likely will require prior approval from the insurance company.

Clarence &quot;Mark&quot; Christiansen · Answer

Check with your health care team on this one but yes, generally speaking Medicare covers genetic testing if it's deemed "medically necessary." If the test you want is based on family history, your chances are good that Medicare will approve it.

Answered by Clarence "Mark" Christiansen on April 4, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Yasmery Vargas · Answer

Unfortunately, there are requirements that must be met and a physician must confirm it is medically necessary. In most cases the question is best asked directly to your Healthcare provider and/or your specific insurance company to see if there are accommodations for your particular situation.

Answered by Yasmery Vargas on April 15, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Glenn Quinn · Answer

Generally, Medicare does not cover preventive genetic testing or testing to detect undiagnosed diseases or predispositions. However, Medicare Part B may cover genetic testing for certain conditions, like diagnosing inherited disorders or guiding medical treatment decisions, if ordered by a physician and deemed medically necessary. For example, genetic testing for specific cancer risks or to determine how a person may respond to specific medications might be covered.

Answered by Glenn Quinn on April 20, 2025

Broker Licensed in FL, AL, AR & 13 other states

Answered by Glenn Quinn Medicare Insurance Agent

John Zentner · Answer

Medicare can cover genetic testing to assess cancer risk based on family history, especially for individuals with a known issues in their family or who meet specific criteria for hereditary cancer risk assessment. However, Medicare generally doesn't cover genetic testing for pre-symptomatic screening or to simply determine an individual's risk of developing an inherited condition. It is always best to check your plan first to make sure there are no hidden cost surprises.

Answered by John Zentner on April 28, 2025

Agent Licensed in CA

Answered by John Zentner Medicare Insurance Agent

Gary Henderson · Answer

Medicare typically covers genetic testing that's used to diagnose or guide treatment for a specific health problem, but not to predict risk or detect undiagnosed conditions.

Suzanne Lamperti · Answer

Unfortunately thus test us NOT covered by Medicare. Although it should be, because it would help Americans take the necessary steps to avoid getting cancer.

Darko Bozic · Answer

Generally, no. Medicare might cover it if your doctor orders to help with your current treatment. If it is purely for preventive informational purposes it most likely will not be covered.

Charles Borg · Answer

I don’t think so. There would usually have to be a diagnosis to.  be covered for a genetic test procedure.

Patrick Stinson · Answer

Factors Influencing Medicare Coverage:
Clinical Indications: You need a clinical indication for germline (inherited) testing for hereditary cancer. This means your doctor must recommend it based on your specific situation and family history. 
Risk Factors: You must have risk factors for germline (inherited) cancer. 
No Prior Testing: You must not have been previously tested for the same germline genetic content. 
FDA Approval: The test must be approved by the FDA. 
Medical Necessity: The test must be medically necessary and ordered by a physician.