Is a Breast Cancer Gene Test Covered by Insurance?

One of the things that the passage of the Affordable Care Act (ACA), or Obamacare, brought about was to ensure that underserved groups would enjoy access to necessary preventive healthcare services. This includes coverage for women, children, the elderly, the disabled, and more.

In terms of women’s health, a wide variety of services are now covered as part of the minimum essential coverage standards. Preventive women’s health services include annual well-woman visits (for physical examination and pap tests), access to FDA approved contraceptives, mammograms and colonoscopies, STD testing and counseling, and certain support services for pregnant women and new mothers, among other things.

As most women are aware, mammograms are designed for early detection of breast cancer (or other breast diseases) and are considered a form of preventive care. However, many women would prefer to know if they’re at increased risk of breast cancer due to genetic factors before they ever find a lump and deal with the surgery, chemotherapy, and/or radiation that follow.

Science has discovered certain genetic markers, known as “breast cancer genes” that indicate increased risk for developing breast cancer. What are these genes? Who should get tested? Most importantly, is this form of preventive care covered under Obamacare?

What are Breast Cancer Genes?
Scientists have managed to isolate certain genes, or more accurately, gene mutations, that indicate an inherited risk factor for the development of breast cancer. The most well-known genetic markers are referred to as breast cancer genes 1 and 2 (more commonly referred to as BRCA1 and BRCA2), these genes can be tested for to let women know if they harbor increased risk of developing certain cancers so that they have the opportunity to take preventive measures before developing cancer.

Only a small percentage of women who undergo BRCA1/2 testing are found to have genetic mutations, although this doesn’t necessarily exclude those without mutations from developing cancers. BRCA1 carriers have a 55-65% chance of developing breast cancer by age 70 while BRCA2 carriers have about a 45% chance of developing breast cancer by age 70 – this as opposed to the 8% risk for those who are neither BRCA1 or BRCA2 carriers.

Who Should Get Tested?
There’s no real reason for alarm if you have little or no history of breast cancer in your family. Since the genetic mutation is inherited from parents, there’s a good chance that others in your family will have had breast cancer before you.

In fact, it is not generally recommended for those with few risk factors to undergo breast cancer gene testing. If, however, other family members have tested positive for these genetic mutations, other family members (male included) have been diagnosed with breast cancer under the age of 50, or you, yourself were diagnosed with breast cancer under the age of 50, breast cancer gene testing may be recommended.

It is recommended for those that have a family history of breast cancer, since this group is at much higher risk than average for inheriting the BRCA1/2 gene mutations.

Are Tests Covered?
Now for some good news. Thanks to the ACA, this form of testing is considered to be preventive care and is therefore included as part of your mandatory health coverage. If you and your primary physician or other healthcare provider have determined that BRCA1/2 testing is in your best interest, you shouldn’t have to pay out of pocket for the procedure.