Topic: Medicare and genetic testing

Forum: Genetic Testing — ATM, BARD1, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, RAD51C, RAD51D, STK11, TP53, mismatch repair genes (MLH1, MSH2, MSH6, PMS2, EPCAM), and VUS (variants of unknown significance)

Posted on: Sep 21, 2022 11:15PM

Posted on: Sep 21, 2022 11:15PM

rainbowmouse wrote:

I just was assessed at the high risk breast clinic and one of the recommendations was genetic testing. I'm all for that but I can't find anywhere whether Medicare covers it or now. I'm just wondering if anyone here has experience with that situation?


Thank you!

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Jan 6, 2023 01:48AM rainbowmouse wrote:

In case anyone comes along searching for this in the future this was my experience. I met with the genetics counselor and she was concerned about a possible genetic componenet due to a heavy number of cases of cancer on my father's side, a few of which can be associated with a higher risk of breast cancer. So that qualified me for the testing. It was paid 100% by Medicare and would have only been $250 if I hadn't been covered. I wound up with a negative result on the screening, thankfully.

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Jan 6, 2023 10:45AM threetree wrote:

rainbowmouse - Thanks for posting this. I have a couple of cases on my father's side (and my sister) and have wondered about the genetics. What I read online was that Medicare would not pay, unless you were diagnosed something like in your 40's or younger. I was 66. I have two daughters and I'd like to let them know if there is anything genetic, but it was my understanding that Medicare would not pay in my case, and that if I paid out of pocket it could run close to $1000.00, so I have been hesitant. I was also thinking that if the genetic cases get diagnosed in one's 40's and mine wasn't, then maybe my daughters don't have any higher than normal risk. My sister was diagnosed in her early 40's and has been fine for 20 years, as it was caught early. She "claims" to have gotten the genetic test and said there was nothing there, but she has some serious problems with the truth and will often say things for attention, so I have to eliminate anything she has said about the situation, unfortunately.

Do you know if just a consult with the genetic counselor is covered by Medicare? Maybe the genetic counselor could give me more info on both the likelihood of a family genetic possibility and whether Medicare would cover in my case. They do have a genetic counselor at the center I go to. I am very concerned for my daughters, as one turned 40 last year, and the other is 39 this week-end. Thanks so much!

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Jan 6, 2023 11:58AM alicebastable wrote:

rainbowmouse, my screening was negative. My dad had kidney cancer and skin cancers. His sister had breast cancer. My mom had breast cancer. Her mother had uterine cancer. I have had ALL of these cancers. Just because the genetics say there's no connections doesn't mean you are in the clear. Stay vigilant and continue with mammograms and other screening.

Total hysterectomy for endometrial cancer 2008, MOHS surgery on face for skin cancer 2016, lumpectomy for breast cancer 2018, nephrectomy for kidney cancer 2018. I want a new hobby. Dx ILC, Left, 1cm, Stage IA, Grade 1, ER+/PR+, HER2-

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