BRCA test cost: what patients pay in practice

Most people tested for BRCA1 or BRCA2 mutations pay nothing out of pocket. Insurance (including Medicare, commercial plans, and ACA marketplace plans) typically covers testing when clinical criteria are met. This guide covers what insurance does and does not cover, what happens when you do not meet clinical criteria, and what to do if you are otherwise underinsured.

Who does and does not pay for BRCA testing

Patients with insurance meeting clinical criteria

Under the Affordable Care Act, USPSTF-recommended BRCA-related risk assessment and testing is a covered preventive service. Eligible women pay no deductible, copay, or coinsurance. Medicare covers germline BRCA testing for patients with a personal history of cancer consistent with a BRCA-related syndrome.

Per Myriad Genetics’ affordability page, the majority of patients tested through Myriad pay no out-of-pocket costs. Foundation Medicine’s tumor testing reports that 87 percent of patients pay $0. Similar dynamics apply to the other major testing companies.

Patients who exceed manufacturer financial assistance thresholds

Myriad’s financial assistance program caps out-of-pocket costs at $295 for patients who qualify as underinsured. Other test providers maintain similar programs with their own eligibility rules.

Patients paying cash

Some patients choose direct-to-consumer testing and pay cash to avoid insurance involvement or physician referral. Representative self-pay options in the U.S. market:

• Color Health Extended Cancer Panel. Approximately $249 for a 30-gene hereditary cancer panel. Optional genetic counseling included. No physician order required.
• Myriad financial assistance program. For underinsured patients at Myriad, $295 maximum out-of-pocket.
• Invitae test catalog. Invitae is now part of Labcorp; current self-pay pricing is available through the Invitae site.
• 23andMe Health + Ancestry Service. The $199 service includes an FDA-authorized test for three specific BRCA founder mutations common in Ashkenazi Jewish populations. It does not sequence the full BRCA1 or BRCA2 genes. A negative result from 23andMe does not rule out BRCA mutations. For clinical decision-making, use a clinical-grade panel (Myriad, Invitae, Color, Ambry, or a hospital lab).

The ACA preventive-care rule

The Affordable Care Act requires most health plans to cover specific preventive services without any patient cost-sharing. No deductible, no copay, no coinsurance. USPSTF-recommended BRCA-related risk assessment and testing is on that list for women who meet clinical criteria.

Eligibility for $0 coverage under the ACA

A woman qualifies for ACA-mandated coverage of genetic counseling and testing if she has both of the following:

• A personal or family history suggestive of a BRCA-related cancer, as identified by a validated family-history screening tool such as the FHS-7 or PREMM
• No prior diagnosis of a BRCA-related cancer requiring testing

If you meet USPSTF criteria, your insurance must cover genetic counseling and, where indicated, testing at zero out-of-pocket cost.

This rule covers preventive testing for risk assessment. If you have already been diagnosed with cancer and your oncologist orders BRCA testing to guide treatment (for example, to determine PARP-inhibitor eligibility), that is diagnostic testing rather than preventive. It is usually covered by commercial insurance and Medicare, but subject to your plan’s regular cost-sharing.

Medicare coverage

Medicare covers germline BRCA testing for beneficiaries with a personal history of cancer consistent with a BRCA-related syndrome, under specific clinical criteria in Medicare’s national coverage determination. Medicare does not cover preventive BRCA testing for beneficiaries who have never had cancer. A Medicare beneficiary with a family history of BRCA-related cancer but no personal cancer diagnosis will generally need to pay out-of-pocket or use a manufacturer assistance program.

If you have no insurance

Three options exist for patients without insurance or who do not meet coverage criteria:

1. Myriad’s financial assistance program. Out-of-pocket is capped at $295 for qualifying underinsured patients. Apply when the test is ordered.
2. Direct-to-consumer cash pay. Color offers its Extended Cancer Panel at approximately $249 without insurance billing and includes genetic counseling.
3. Research-based testing. Some academic medical centers and research programs offer free hereditary cancer testing through institutional review board-approved research protocols. Ask your hospital’s genetics service.

Step-by-step: getting tested

1. See a genetic counselor. This is the standard of care, not a shortcut you can skip. A counselor takes a thorough family history and determines which test panel is clinically appropriate. Ask your oncologist or primary care doctor for a referral, or search the National Society of Genetic Counselors directory. Many counselors offer telemedicine.
2. Your counselor or physician orders the test. The lab ships a saliva kit or you provide a blood sample at the clinic.
3. The lab verifies insurance. The lab’s benefits team confirms coverage and notifies you of any out-of-pocket cost before the sample is processed.
4. Results return in two to four weeks. Your genetic counselor interprets them with you.

What a positive test means

A BRCA1 or BRCA2 mutation indicates elevated lifetime risk for breast, ovarian, prostate, pancreatic, and some other cancers. It does not mean cancer will definitely develop. A positive result can change clinical recommendations for screening frequency and, in some cases, risk-reduction options.

For patients already diagnosed with cancer, a BRCA mutation can determine eligibility for PARP inhibitors such as Lynparza (olaparib), which are specifically effective against BRCA-mutated tumors.

Other hereditary cancer panels

BRCA1 and BRCA2 are two of many genes associated with hereditary cancer risk. Modern testing is almost always done as a multi-gene panel rather than as BRCA-only testing. The coverage and affordability picture is similar for most major panels: with appropriate clinical indication, most insured patients pay nothing.

Common commercial panels include Myriad MyRisk, Invitae’s hereditary cancer panels (now offered through Labcorp), Color’s Extended Cancer Panel, and Ambry Genetics CancerNext. Gene counts and exact content vary by panel and by indication.

Tumor-specific (somatic) molecular testing is a separate category that guides treatment decisions rather than assessing hereditary risk. Common somatic tests include Foundation One CDx and Guardant360.

Next

• Genetic testing for hereditary cancer: clinical criteria and the testing process
• Cancer biomarkers explained: the difference between hereditary (germline) and tumor (somatic) testing
• Lynparza (olaparib) cost: the PARP inhibitor for BRCA-mutated cancer
• Financial assistance for cancer patients