Does Medicare Cover Genetic Testing?

Does Medicare Cover Genetic Testing? text overlaying image of a dna strand The Centers for Medicare and Medicaid (CMS) has begun covering genetic sequencing in 2018. It began when the FDA approved FoundationOne CDx, a test that can detect over 300 types of gene mutations. While Medicare does cover genetic testing to help detect possible health conditions it only covers a few types of genetic testing, and you have to meet certain criteria. Typically, genetic testing is used to screen, identify, or plan a specific treatment. That means without having certain symptoms or being at risk for certain health conditions Medicare won’t cover genetic testing. In most cases your doctor will be the one who advises you to get genetic testing done. For example, if you have a hereditary risk for a certain disorder. Along with testing to check the effectiveness of a new medication, this would help your doctor determine a better treatment plan. 

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Types Of Genetic Testing

Mainstream adult genetic testing covers several conditions. These are usually categorized by function:

  • Diagnostic, Predictive, or Presymptomatic – These tests are for patients who may have symptoms or know a certain medical condition runs in their family. A genetic test can show indicators for various cancers, polycystic kidney disease, and hemochromatosis. However, having indicators does not mean you will develop the disease. It just means you have the genes that can trigger it.
  • Carrier – Even if a person never gets sick or shows signs of a disease, they may be a genetic carrier for that disease. A test that looks for DNA markers that show a person is a carrier of an inherited disease can tell them if they could pass this gene on to a child or if they already have. If the other parent is also a carrier, this test can also tell them if they have already passed this gene onto a child.
  • Pharmacogenomic – The study of genetics is a big part of learning how the body breaks down drugs or responds to them. In some cases, a person’s genes can show whether or not a certain treatment will work or cause a bad response. This can help doctors tailor their treatment plan to the patient’s needs. Which can improve the chances of the patient’s health and healing going well.

Are There Risks To Genetic Testing?

Most genetic tests have very few risks and may be as easy as swabbing the inside of a patient’s cheek. Other tests may need a sample of blood. Which can cause some of the usual side effects of having blood taken. This could lead to redness or soreness in the place where the injection was given. Genetic testing, like any test, can also lead to changes in your mental health. Depending on how bad the scenario is, genetic testing can take an emotional toll. This could happen while deciding if a genetic test is needed, while waiting for the results, or after a genetic problem has been confirmed. This is natural since the possibility of serious medical conditions can be scary. 


Keep in mind, genetic tests might be able to find out if a person has genetic markers linked to hereditary conditions. But they don’t tell us how likely it is that a person will get the disease. Or how signs might change or get worse over time. The health care worker who does the genetic test can tell you if there are any limits to the test and what it is usually used for.

Genetic Testing With Medicare

As we noted before, Medicare will pay for only a few types of genetic testing if you meet Medicare’s standards. If your doctor suggests that you get a genetic test it will most likely be covered because it will stem from a set of symptoms you’ve been showing. These are the genetic tests Medicare will cover:

  • Molecular Diagnostic Genetic Test (MDT) – Involves looking at gene sequences for changes that could cause certain illnesses.
  • Next Generation Sequencing (NGS) – NGS is a type of genetic testing that looks at many different parts of a person’s DNA at once. It helps doctors figure out how changes (mutations) in your DNA can show risk factors. And help them figure out what’s wrong with you.
  • Pharmacogenomics (PGx) – As we noted above, this is a type of test designed to learn how your body will react to certain types of medication.

Medicare also pays for NGS genetic tests for both acquired cancer (caused by gene mutations) and germline cancer (which is passed down from parent to child). Medicare will also cover some types of genetic tests that are used to diagnose cancer. These tests help find biomarkers, which are signs of abnormal cell activity in your body. For example, Medicare pays diagnostic tests for breast cancer, prostate cancer, ovarian cancer, and pancreatic cancer for people who have never been tested for specific mutations (BRCA).

BRCA Testing

Medicare pays for genetic tests that look for changes in the BRCA 1 and BRCA 2 genes. Which are the breast and ovarian cancer genes. Medicare also pays for other genetic tests that can tell if someone has a BRCA gene. Research shows that both men and women with the BRCA 1 or BRCA 2 gene mutations are much more likely to get breast and ovarian cancer than people who don’t have these gene mutations. A test like NGS that looks at many genes at once can find changes in BRCA 1, BRCA 2, and other genes. This can help doctors figure out if someone has cancer or not. There is criteria to get testing for BRCA 1 and BRCA 2:


  • You have to have pre-testing genetic counseling
  • Testing must be relevant to your family history of cancer
  • National Comprehensive Cancer Network rules say that you must meet certain standards to be eligible for testing for breast cancer or another type of cancer and one other type of inherited cancer.

When Does Medicare Cover Genetic Testing?

Medicare will pay for genetic testing for certain conditions and PGx for medications. As long as your doctor orders it and it is done in a lab that is approved by the Clinical Laboratory Improvement Amendments (CLIA).


Medicare covers genetic diagnostic testing for specific gene changes and NGS multi-gene panel testing if you have been diagnosed with cancer. If you meet Medicare’s requirements, NGS testing is also covered for other inherited diseases. Such as heart problems (cardiomyopathy, which is a problem with the heart muscle) and arrhythmia. Coverage for the Individual Plan may change based on where you live. For some medicines, PGx testing is also covered. Many medicines are broken down in the liver by enzymes like CYP2C19, CYP2D6, and CYP2C9. Doctors and pharmacists can better focus your medication therapy by testing your genes for these enzymes.


Medicare will pay for PGx testing for certain drugs like warfarin, clopidogrel, amitriptyline, and others if certain conditions are met. Your doctor can tell you more about the perks of PGx testing for you. The company that gives you your Medicare plan can tell you which PGx tests are covered by your plan. Medicare also lets MACs decide if they will cover NGS genetic tests that are not FDA-approved and other types of NGS genetic tests. For instance, for other types of cancer and other health problems.

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Cost Of Genetic Testing

How much a genetic test will cost you varies based on the type of test, how it’s done (saliva or blood sample), and whether or not you meet the requirements for Medicare coverage. If your test is covered, you won’t have to pay anything as long as your provider accepts Medicare assignment. This means they agree to the payment terms set by Medicare. Costs for genetic tests can range from a few hundred to a few thousand dollars. So, it is important to make sure that Medicare pays for the test. Medicare has rules about who can get testing, and your doctor must give you an order for it. Medicare Administrative Contractors (MACs) may also have eligibility standards based on where you live.

Counseling With Genetic Testing

Medicare rules say that a “cancer genetics professional” like a doctor can give genetic advice. Which is covered, but you have to be a patient of that doctor. Certified genetic counselors are not yet seen as health care experts by Medicare. So, if you see a genetic counselor who is certified, your visit may not be paid. Certified genetic counselors have special training in genetics and therapy, so they can help you understand how your genes affect your chances of getting diseases like cancer. Based on the rules in place, Medicare doesn’t pay for genetic advice for any screening or prevention tests. Your Medicare plan provider can tell you more about the coverage standards for genetic counseling.

Get Covered With EZ

Medicare is great, but sometimes it can be hard to understand. Even after you sign up, you’ll still have to make some decisions about your health care. Don’t worry about asking questions. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you. EZ can help you sign up, buy a Medicare Supplement Plan, or just think about your choices. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our certified agents at 877-670-3602 to get started.

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Foods Proven To Prevent Cancer

Helping prevent cancer is so easy it might surprise you. It is as simple as adding the right types of food to your diet to decrease your chances! While there is no magical fruit or vegetable that will cure cancer or completely prevent cancer, there are foods you can eat to lower your risk of getting cancer. Certain foods can help boost your immune system, and protect your body to fight off diseases and cancer. Research has shown there is a link between cancer and your diet. The other factors are your environment and genetics, but you can change the chances of getting cancer up to 70% by improving your diet. A lot of Americans have an unhealthy diet, and would rather eat a cheeseburger than vegetables. However, foods such as garlic, broccoli, and fruits can not only lower your risk of heart disease, but also lower your risk of cancer. It is definitely worth adding to your diet as often as possible.

There is no secret that how we treat our bodies, and what we put into it, is what we get back from how it functions. Making small changes to your diet can make a difference to your health long-term. Antioxidants are key to boost your immune system and protect against cancer cells. Here are some nutritious foods to eat and what they provide your body with:

Many vegetables such as carrots, garlic, and brocolli have antioxidants that help fight cancer cells.
Many vegetables such as carrots, garlic, and brocolli have antioxidants that help fight cancer cells. Some can even shrink current cancer cells.


Broccoli is considered a superfood that prevents cancer due to containing sulforaphane. Sulforaphane was tested and has shown to reduce the size and number of breast cancer cells up to 75%. Hundreds of studies in mice have shown that broccoli also reduces prostate, colorectal and colon cancer. Be sure that when you cook broccoli to add to your meals, that you do not microwave it. Microwaving broccoli kills almost all of its cancer-protective nutrients. It is best to eat it raw, or boil it over the stove for 6 minutes to reduce losing too much of the good stuff.


Not only can garlic help lower your blood pressure and risk of heart disease, but it has been shown to kill off cancer cells. Multiple studies have shown that the active component in garlic named allicin lowers the risk of stomach cancer and prostate cancer. Add garlic to your meals when you cook, the fresher the better. You may have stinky breath, but you will have a healthier body!


Carrots contain beta-carotene which is an antioxidant that may protect cell membranes from the growth of cancer cells. It has been reduced to lowering lung cancer, and cervical cancer. Eat carrots when they are cooked to benefit its antioxidants properties more. Steam or boil the carrots for most nutritional value.


Not only are tomatoes yummy, but they have the potential to help your body fight off prostate cancer and heart disease. A phytochemical called lycopene gives tomatoes their red color, and its anticancer properties as well. Several studies have shown that the increased intake of lycopene lead to a reduced risk of prostate cancer. Add fresh tomatoes to your sauces, salsa, and sandwiches.

Olive Oil

Adding olive oil to your diet can reduce a woman’s chances of breast cancer by almost 70%. Studies have shown that around the world, countries who used olive oil more, had decreased rates of colorectal cancer. Try to swap other oils for olive oil when cooking, and for drizzle on salads and marinades.


Berries carry so many antioxidants and vitamin C, which aids in the destruction of cancer-causing cells. Strawberries, raspberries, and blueberries carry a lot of antioxidant power. Not only can berries prevent the growth of cancer cells, but studies have shown that people with cancer who eat berries such as blackberries slowed cancer progression and reduce the growth of the cells. Grab some berries at your local store and find ways to incorporate it in your day as a snack, or added to salads and smoothies.


Nuts can decrease the risk of colorectal, pancreatic, and endometrial cancers.
Nuts can decrease the risk of colorectal, pancreatic, and endometrial cancers. Find ways to add them to your diet.

What is yummy and goes well with berries? Nuts! Eating nuts regularly can decrease the risk of colorectal, pancreatic, and endometrial cancers. Brazil nuts are high in selenium which protects your body from lung cancer, and walnuts were studied to decrease breast cancer cells by 80%. Add some nuts to your salads, cooked meals, and in some homemade trail mix.

There are so many benefits to eating healthier, especially when it comes to fighting off cancer. Research is conducted everyday, and has shown that your diet has a large impact on your overall health and risk of cancer. Some foods will not only reduce the speed and growth of cancer cells, but they can prevent it all together. Incorporate the foods mentioned more often into your diet, and not only will you begin to feel better, but your body will have a higher chance of beating cancer cell’s butts.

Ways to Lower Your Risk Of Colon Cancer

Over the years, the number of people over the age of 55 with colon cancer has gone up by 3%. According to statistics from research, it is estimated that over 100,000 adults in the U.S. will be diagnosed with colon cancer this year. Of these numbers, there is expected a death toll of over 50,000. Colon cancer is the third most diagnosed cancer every year, however, if it is found early then it can be cured. What’s more crucial is to prevent it from happening by practicing ways of lowering your chances. Following a few simple steps every day can improve your health, lower your risks of colon cancer, and save your life.

Getting screened will help detect cancer and increase your chances of beating it.
Getting screened annually will help detect cancer at an early stage,increasing your chances of getting rid of it.

Get Screened

This method is the most important one you must do to for prevention of colon cancer. Getting screened will allow doctors to find any kind of growth or polyps so they can remove them before it turns into cancer. The purpose of these screenings is to find cancer long before signs of symptoms develop. Something so simple as going to get a screening/colonoscopy done can ultimately save your life. It is recommended by the American Cancer Society to begin testing at the age of 45. But if you worry due to issues or family history, you should consult with your doctor. Getting a head start is the key to success, the same goes for your health.

Healthy Diet

Your diet plays an essential part in your body’s health. The nutrients you put into your body are what fuel your body and give it the energy to protect it from threats. Researchers have linked eating a lot of vegetables, fruits, and whole grains with a lower risk of colon cancer. Red meat and processed meats give you a higher risk of colon cancer. Always be mindful by what you are putting into your body, because that can be a factor of what help you or hurt you.

No Smoking

Smoking is a bad habit that has many negative effects on your body. It can cause lung cancer, and increase your chances of developing and dying from colon cancer. This is especially true and serious for long-term smokers. Quitting smoking is the best thing you can do for your health. If you need help quitting, seek help from your doctor or a counselor, this will increase your chances of quitting.

Watching your weight can decrease your chances of colon cancer. Focus especially on your mid section.
Watching your weight can decrease your chances of colon cancer. Focus especially on your mid section.

Watch Your Weight

Being overweight raises your overall risk of cancer. Research shows that many different kinds of cancer has been linked to being overweight, and obesity. Having a lot of belly fat has been linked to colon cancer. It is safe to maintain a healthy weight for your height and avoid gaining too much weight, especially around your midsection.


There are many benefits of exercising, it will make your heart healthier, give you a mental boost, and reduce your risk of cancer. Any kind of physical activity from taking a long walk with a friend, to regular to riding a bike can lower your risk of colon cancer. Thirty minutes a day of any moderate physical activity will steer you away from cancer.

Limit Alcohol

Consuming a lot of alcohol increases your risk of colon cancer, especially among men. If you are going to have a drink, then it is important to do it in moderation. Talk with your doctor, friend, or a counselor if you have a problem and want to cut down or quit, because it is beneficial to your heart and body’s overall health.

Colon cancer develops more in men than women, and more in those 55 and older. Taking care of our body is the most reliable ways to prevent cancer. We are only given one body, so it is essential to try to keep it as healthy as we can with these small, yet powerful methods. Get screened, eat right, work out, avoid smoking, and drink in moderation. It is never too late to start, so treat your body right and it will do the same for you.