BRCA genetic testing identifies inherited mutations within the BRCA1 and BRCA2 genes. These genes normally produce proteins that repair damaged DNA, preventing uncontrolled cell growth. Mutations disrupt this function, significantly increasing an individual’s lifetime risk of developing certain cancers, particularly breast and ovarian cancers.
Typical Costs of BRCA Testing
The cost of BRCA genetic testing varies widely based on insurance status and the specific test performed. Without insurance, the cash price for BRCA1 and BRCA2 testing can range from $250 to several thousand dollars, sometimes up to $5,000. Some laboratories offer a self-pay rate as low as $250 for these specific genes, though more extensive testing increases the total expense.
With health insurance, out-of-pocket costs are typically lower, often ranging from $0 to $250. This amount depends on whether their deductible has been met, the co-insurance percentage, or any applicable co-pays. Higher costs can occur if a plan has a substantial, unmet deductible.
Factors Affecting BRCA Test Cost
Several elements contribute to the variability in BRCA genetic testing costs, extending beyond just insurance status. The specific type of genetic test ordered significantly influences the price. A test focusing solely on BRCA1 and BRCA2 genes is more affordable, while multi-gene panels examining a broader range of cancer-associated genes can cost more, sometimes up to $2,000 or several thousand dollars. At-home genetic tests, typically priced between $200 and $300, screen for a limited number of common BRCA mutations and do not provide a comprehensive analysis.
The choice of testing laboratory also plays a role in the final cost. Commercial laboratories like Myriad Genetics, Invitae, or Ambry Genetics have their own pricing structures. These laboratories may offer varying rates for the same type of test, and some may have different programs or discounts available. Additionally, the inclusion of genetic counseling, which is an important part of the testing process, can add to the total expense. Pre- and post-test sessions, where individuals discuss their family history, risk factors, and test results, can average around $213 if billed separately, though some services may bundle this into the overall cost.
Geographic location can also influence BRCA testing costs, as healthcare service prices differ by region or country. The general healthcare market dynamics in a given area can affect laboratory fees and associated professional services.
Insurance Coverage and Financial Assistance
Insurance coverage for BRCA genetic testing largely depends on meeting medical necessity criteria, often guided by recommendations from organizations like the National Comprehensive Cancer Network (NCCN). Insurers typically cover testing for individuals with a personal or family history of cancers associated with BRCA mutations, such as breast, ovarian, pancreatic, or prostate cancer, especially when diagnoses occurred at younger ages or involve multiple affected relatives. Pre-authorization from the insurance company is frequently required before testing to ensure coverage.
Even with insurance, individuals may still incur out-of-pocket costs, including deductibles, co-insurance, and co-pays. A deductible is the amount an individual must pay before their insurance begins to cover costs. Co-insurance is a percentage of the total cost paid after the deductible is met, and co-pays are fixed amounts for specific services. The Affordable Care Act (ACA) mandates coverage for BRCA genetic counseling and testing as a preventive service for women at increased risk based on family history, often without co-payment for in-network providers. Medicare coverage typically applies to individuals with a personal history of cancer, and Medicaid coverage varies by state.
Various financial assistance programs help manage the cost of BRCA testing for those who are uninsured or face significant out-of-pocket expenses. Many genetic testing laboratories, including Myriad Genetics, GeneDx, Baylor Genetics, Quest Diagnostics, and Natera, offer patient assistance programs, sliding scale fees, or payment plans based on income and financial need. Non-profit organizations like Facing Hereditary Cancer Empowered (FORCE) and the National Organization for Rare Disorders (NORD) also provide resources and connections to low-cost or no-cost testing options for eligible individuals. These programs aim to make testing accessible, with many labs offering reduced self-pay rates for those who qualify.