Medicare coverage tends to focus on treatment of present diseases rather than preventing future disease. For this reason, Medicare does not cover almost any genetic screen or preventative test, with one exception. For individuals who are at risk for colorectal cancer, Medicare pays for a focused genetic screen of stool. Biomarkers can appear as early warning signs for the disease, prompting Medicare to pay for the screen every three years. Unfortunately, Medicare will not pay for any other preventative screenings.
Medicare and Diagnostic Genetic Tests
While Medicare tends to skimp on preventative screenings, Medicare and genetic testing work well together for diagnostic tests. Medicare has a sprawling coverage of different genetic tests, many of which confirm prior diagnoses or help narrow down treatment plans. One of the more common genetic tests is a cardiac genetic test for warfarin sensitivity. Warfarin is a blood thinning drug that has a narrow range of dosage effectiveness. Doctors often order genetic testing to help find the perfect dosage quicker. These tests can be administered in a professional setting or at home with a personal testing kit like Kardia Guard.
It is worth noting that if you are tested and find a gene mutation, Medicare does not cover tests for potentially affected family members.
With the rapid advancement of genetic testing, Medicare and genetic testing scams have become uncomfortably common. While there is not a one-stop-shop for determining what a Medicare scam is, keeping the information in this article in mind will help you parse what is true and what is fraudulent. There are also a few things to watch for that are red flags for scammers.
- on-site genetic testing – If you doctor does not order your test or the test is performed outside of a doctor’s office, you want to be cautious of a scam. If the test was not ordered by your doctor Medicare will not pay for it.
- Avoid giving out your Medicare information to anyone that isn’t your doctor or a recommended provider.
- Do not accept unsolicited mail-in genetic testing kits. Mark them return to sender and make sure you document who sent it and when you returned it.