February 20th 2026
By Ari Parker
Learn when Medicare covers genetic testing, eligibility requirements, approved tests, and what costs you may still need to pay.
Genetic testing can provide important medical information. It looks at your DNA, chromosomes, or proteins to help diagnose genetic conditions. It can also evaluate your risk for certain diseases and show how well a specific medication might work for you. Your doctor might recommend genetic testing to you. Or you might want to get genetic testing done because you have a family history of certain conditions.
In this article, we’ll answer the question: Does Medicare cover genetic testing? We’ll also explain how genetic testing coverage works under Part B and introduce you to the types of tests covered.
Medicare covers genetic testing when it is deemed “reasonable and necessary.” This usually means that the patient has symptoms or has been diagnosed with a genetic condition.
Medicare won't pay for genetic testing that is just for general wellness or assessing risk factors if it doesn't impact diagnosis or treatment.
In some cases, Medicare also covers genetic counseling before and after testing.
In some situations, Medicare does cover genetic testing.
Medicare Part B covers most genetic testing, which includes outpatient and physician-ordered tests. Medicare Part A may cover genetic testing ordered during a hospital stay. Medicare Part C (Medicare Advantage) has similar rules. However, coverage varies between Medicare Advantage plans, so it’s important to check with your plan. Medicare Part D does not cover genetic testing.
Medicare generally covers genetic testing when a doctor determines it is medically necessary. This can include hereditary cancer testing after a cancer diagnosis or genetic tests needed for diagnosis when clinical signs and symptoms are present.
Typically, “medically necessary” means that a person has been diagnosed with or is showing symptoms of a particular condition, and the results of genetic tests will impact their treatment. Medicare genetic testing coverage might also include tests for medication management, known as pharmacogenetics. This testing helps predict how patients will respond to certain medications.
Medicare typically doesn’t cover genetic screening for seniors when the person has no diagnosis or symptoms. However, there is one exception: Medicare Part B covers a multi-target stool DNA test once every three years to screen for colorectal cancer. This test is fully covered for beneficiaries aged 45 to 85 who have no symptoms of colorectal disease and are at average risk for developing colon cancer.
Genetic tests performed for carrier screening or prenatal diagnostic testing are also not covered by Medicare.
Medicare also doesn’t cover ancestry and genealogy testing or consumer-initiated direct-to-consumer tests, such as 23andMe or AncestryDNA.
Any genetic tests covered by Medicare need to have an established clinical utility and be approved by the Food and Drug Administration (FDA). In some cases, tests may need to be performed at a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory. It’s also important to note that most Medicare-approved genetic tests are only covered once, as the results won’t change.
In this section, we’ll go over the specific types of genetic tests that Medicare covers.
BRCA1 and BRCA2 testing are commonly used to detect breast and ovarian cancer risk. Medicare may cover BRCA testing for beneficiaries who have a personal history of breast, ovarian, pancreatic, or prostate cancer that is suspected to have a hereditary origin. Both diagnostic and predictive testing may be covered, as is Medicare genetic counseling before and after testing. Medicare only covers one BRCA1 and BRCA2 test per beneficiary per lifetime.
Medicare may also cover hereditary cancer panels when they are “reasonable and necessary.” This includes testing for Lynch syndrome. It’s a genetic disorder that increases the risk of some cancers, like endometrial and colon cancer. Coverage usually requires a personal history of associated cancers, abnormal tumor results, or a known familial mutation. Comprehensive multigene panels may be covered if a person has cancer linked to a specific gene, and test results can help in treatment planning.
Tumor genetic testing is covered when it helps guide treatment decisions. This includes directing immunotherapy and precision medicine or finding targetable mutations. Laboratories, including Foundation Medicine, offer these tests. Coverage is available to those with advanced cancer. This includes Stage III or IV cancers, as well as recurrent, relapsed, refractory, or metastatic cancers.
Pharmacogenetic testing shows how genes influence how we respond to medications. It helps predict how well a medication will work and any possible side effects. Doctors are using this type of testing more and more in practice because it can help make treatment more effective. Medicare covers pharmacogenetic testing for medications known to have gene-drug interactions when it is clinically indicated. This may include:
Warfarin dosing and metabolism
Evaluating antidepressants and psychiatric medications (such as SSRIs and TCAs) after a failed medication trial
Pain medication metabolism
Cardiovascular drug response (such as blood-thinners)
Genetic testing to predict warfarin responsiveness is only covered once in cases where warfarin treatment has been administered for less than five days, and beneficiaries are enrolled in research-based clinical studies.
Genetic testing for cardiovascular issues is usually covered when someone has a clinical diagnosis or when their doctor believes there is a strong indication that their cardiovascular symptoms may be genetically related. This covers:
Familial hypercholesterolemia screening
Cardiomyopathy genetic testing
Arrhythmia syndrome genes
Cardiac amyloidosis
Marfan syndrome and related symptoms
Cardiovascular genetic testing to screen individuals in the absence of symptoms is not covered by Medicare.
Medicare tends to cover neurological and Alzheimer’s disease testing when a person has early-onset Alzheimer’s disease or when symptoms indicate that there may be a genetic link. Medicare may also cover tests for rare dementias and movement disorders in symptomatic people. However, APOE testing is not covered by Medicare. This is because it determines risk and isn’t used for diagnosis.
Medicare may cover other genetic tests on a case-by-case basis.
These tests include:
Hemochromatosis testing (once in a lifetime)
Thrombophilia and clotting disorders
Metabolic genetic disorders
Rare disease diagnosis
If genetic testing is covered and done at a Medicare-approved lab, Original Medicare usually pays 80% of the cost after the deductible is met.
This means that you are responsible for 20% of the fee. However, if Original Medicare does not approve the tests, you may need to pay the full costs. Genetic testing can be expensive, ranging from $100 to over $2,000. This is why it is important that your doctor seek pre-authorization and you get the test from an approved lab. You can also contact Medicare directly to check for coverage by:
Calling 800-MEDICARE (800-633-4227)
Logging in to or creating a Medicare account
For individuals with Medicare Advantage (Part C) plans, out-of-pocket costs can vary, so it’s important to check plan details.
Keep in mind that your doctor will initiate all covered genetic tests. There is a scam targeting seniors, offering them free genetic testing. Don't share your Medicare number or personal info with anyone offering free genetic testing. Also, check your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for any unfamiliar charges. If you notice any, call Medicare.
If coverage is denied, contact Medicare to check if it was a mistake. If it wasn’t and you disagree with the decision, you can submit an appeal. The timeframe that you have to support an appeal varies by the plan. For Medicare Part A and Part B, you have 120 days. For Parts C and D, you have 60 days.
Asking your doctor questions can help you better understand why genetic testing is needed and how your test results will affect your health.
Before ordering genetic testing
Why do you recommend this test for me?
How will the results change my treatment or care?
Does this meet Medicare coverage criteria?
What are my out-of-pocket costs likely to be?
Which laboratory do you recommend?
Do I need genetic counseling?
What happens if I test positive or negative?
About test results and follow-up
What do my results mean for my health?
Do my family members need testing?
What are my next steps based on the results?
Will I need additional testing?
How will this affect my treatment plan?
Medicare usually covers genetic testing if it's needed for medical reasons, ordered by a doctor, and done by approved labs. Your doctor can use the information obtained from genetic testing to help with diagnosis and treatment plans.
Yes, Medicare generally covers genetic testing when medically necessary for diagnosis, treatment planning, or disease prevention in high-risk individuals with a doctor's order. Genetic testing is not covered when used for screening in the absence of symptoms.
Yes, Medicare covers BRCA1/BRCA2 testing if you meet the criteria. This is based on your personal or family history of breast, ovarian, or related cancers.
After the Part B deductible, you pay 20% coinsurance. Typical out-of-pocket costs range from $100 to $2,000+, depending on test complexity.
American Society of Clinical Oncology. (n.d.). Genetic testing coverage & reimbursement. Retrieved from https://www.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/genetics-toolkit/genetic-testing-coverage-reimbursement
Centers for Medicare & Medicaid Services. (2020, December 10). BRCA1 and BRCA2 genetic testing (Local Coverage Determination L36715). https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36715&DocID=L36715
Centers for Medicare & Medicaid Services. (2022, January 30). Genetic Testing for Cardiovascular Disease: Local Coverage Determination L39084. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39084
Centers for Medicare & Medicaid Services. (2025). Local Coverage Determination (LCD): Pharmacogenomic testing (L39995). Medicare Coverage Database.
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39995&ver=5
Centers for Medicare & Medicaid Services. (2024). Pharmacogenomic testing for warfarin response. Medicare Coverage Database. https://www.cms.gov/medicare/coverage/evidence/warfarin
Centers for Medicare & Medicaid Services. (n.d.). Multi‑target stool DNA tests (screening). Retrieved October 29, 2025, from https://www.medicare.gov/coverage/multi-target-stool-dna-tests-screening
Centers for Medicare & Medicaid Services. (n.d.). Preventive and screening services. Retrieved October 29, 2025, from https://www.medicare.gov/coverage/preventive-screening-services
Muller, C., Nielsen, S. M., Hatchell, K. E., Yang, S., Michalski, S. T., Hamlington, B., Nussbaum, R. L., Esplin, E. D., & Kupfer, S. S. (2021). Underdiagnosis of hereditary colorectal cancers among Medicare patients: Genetic testing criteria for Lynch syndrome miss the mark (5:PO.21.00132). JCO Precision Oncology.
https://doi.org/10.1200/PO.21.00132
National Library of Medicine. (2021, July 28). What is the cost of genetic testing, and how long does it take to get the results? MedlinePlus Genetics. https://medlineplus.gov/genetics/understanding/testing/costresults/
Roundtable on Translating Genomic‑Based Research for Health; Board on Health Sciences Policy; Institute of Medicine. (2014, August 19). Assessing Genomic Sequencing Information for Health Care Decision Making: Workshop Summary. Washington (DC): National Academies Press (US). Chapter 5: How Insurers Decide Whether to Pay for Testing. https://www.ncbi.nlm.nih.gov/books/NBK241339/
