How Much Does Genetic Testing Cost? Insurance Insights

Wondering how much genetic testing costs and whether insurance will help cover it? With prices ranging from under $100 to several thousand dollars, the answer depends on the type of test, its purpose, and your coverage. This guide breaks down what to expect so you can make informed decisions about your health and finances.

How Much Does Genetic Testing Cost?  

Genetic testing can cost between $100 and $2,000, depending on the test type, purpose, and complexity. These tests analyze your DNA to detect mutations linked to various inherited conditions.

More than 77,000 genetic tests exist today, helping with early detection, diagnosis, and preventive care.

What Affects the Cost?

Several factors influence genetic testing costs:

• Type of genetic test: Direct-to-consumer genetic tests can cost under $100, complex clinical tests can cost thousands.

• Consultation: Genetic counseling can add to the total cost.

• Number of genetic tests: Getting more than one test or testing for multiple family members raises costs.

• Genetic testing laboratory: Specialized labs typically cost more.

• State sponsorship: Some states cover part or all of the cost of newborn screening.

• Insurance coverage: The out-of-pocket cost of a genetic test can vary depending on whether health insurance plans provide coverage.

Cost by Type of Test  

Direct-to-Consumer Genetic Tests provide information about your heritage and some health-related predispositions. Note that these genetic tests are not regulated. Popular brands include:

• AncestryDNA + Traits $69

• My Heritage DNA Kit $89

• 23andMe Ancestry Service $99

• Mito Core Panel $399

• 10X Health Genetic Test $599

Clinical Genetic Testing diagnoses or predicts genetic disorders in people with a personal or family history of rare inherited conditions. The cost of these genetic tests varies based on their complexity. For example:

• Carrier testing ($100 to $400) detects people who carry a gene that could cause a genetic disorder in offspring if the partner also has the same gene mutation. 

• Single-gene tests ($100 to $2,000) look for mutations in a single gene that can cause a genetic disorder or increase the risk of certain diseases. 

• Predictive genetic testing ($150 to $2,000) identifies genetic mutations that can increase the risk of certain types of cancer or medical conditions like Alzheimer’s disease.

• Pharmacogenetic tests ($200 to $500) look for specific genes that can impact how a person responds to certain medications.

• Whole-exome sequencing ($600 to $1,000) diagnoses rare genetic disorders. 

• Whole genome sequencing ($600) evaluates nearly all of a person’s DNA. 

• Chromosomal microarray tests ($1,000 to $2,500) look for potential genetic causes of autism, intellectual disability, and developmental delay. 

Will Insurance Cover Genetic Testing?  

Health insurers may cover genetic testing if it's deemed medically necessary and ordered by a doctor. Coverage can vary depending on the specific plan, the type of genetic test, the reason for testing, and individual circumstances. Many insurers have specific criteria and require pre-authorization. 

Direct-to-consumer tests are typically not covered by individual or group health insurance plans.

Medicare and Medicaid Coverage

Medicare Part B may cover genetic tests ordered by a physician to diagnose or guide treatment for a medical condition and are deemed medically necessary. 

Medicaid usually covers genetic testing when medically necessary, but coverage policies vary by state. 

Common Insurance Plans and Provider Policies 

Health insurance coverage for genetic testing can vary from plan to plan. Generally speaking, some of the policies of top health insurers in the US include:

• Aetna covers genetic testing to diagnose inherited diseases.

• United Healthcare covers single-gene and known mutation testing for familial cancer risk if proven medically necessary. 

• Kaiser Permanente may cover costs for genetic testing ordered by a doctor. 

• Humana requires preauthorization.

• Blue Cross Blue Shield requires prior authorization.

How to Check Insurance Coverage  

To verify insurance coverage for genetic testing, read your policy documents or contact your insurance company directly. They can tell you if genetic tests are covered under your specific plan and whether any prior authorization is needed. 

Before you contact your health insurance company, make sure you have the name of the test, CPT code (from the lab), ICD-10 code (from your healthcare professional), and possibly also a letter of medical necessity ready. 

Low-Cost or Free Testing Options  

If you are uninsured, you may be able to access affordable genetic testing through financial assistance programs offered by laboratories and non-profit organizations. 

Labs like Myriad Genetics and Ambry Genetics offer reduced rates, deferred payment plans, or financial assistance based on need. 

Organizations like FORCE (Facing Our Risk of Cancer Through Education) and the Basser Center provide resources for finding financial assistance and low-cost genetic testing options.

Genetic Testing During Pregnancy  

Noninvasive prenatal testing (NIPT) is a blood test done on pregnant women to detect genetic mutations. Costs range from $100 to $2,000 or more, and may be covered by health insurance if considered medically necessary.

Genetic testing before and during pregnancy allows for informed decision-making and timely medical care. 

Is Genetic Testing Worth the Cost?

Genetic testing offers several benefits, including:

• Early detection and diagnosis of inherited diseases

• Treatment planning

• Informed reproductive decisions 

Genetic testing can also carry some risks emotionally, physically, and financially. Talk to a genetic counselor to better understand the pros and cons of genetic testing. 

Reducing Out-of-Pocket Costs  

If you're uninsured or your plan doesn’t cover testing:

• Ask labs about payment plans or financial aid. Some laboratories offer payment plans and financial assistance options based on household income and personal circumstances. 

• Use interest-free financing if eligible.

• Explore self-pay options, personal loans, or medical credit cards.

Is Genetic Testing Worth the Cost?  

Genetic testing may be worth the cost depending on your circumstances, the type of testing, and the information gained. Genetic tests can provide valuable insights into potential health risks, guide treatment decisions, and inform family planning. In other words, genetic testing can lead to proactive health management and improved health outcomes. However, it also has limitations, including potential privacy concerns, the possibility of inconclusive results, and the significant cost of genetic testing.