Medicare covers genetic testing when it's diagnostic, ordered to figure out or manage a condition you already have, but not when it's screening a healthy person to predict future disease. That line, diagnostic versus screening, is what decides whether Medicare pays your bill. If your doctor just mentioned a genetic test, which side it falls on is the question that matters.

In This Guide

Does Medicare Cover Genetic Testing? The Short Answer

Medicare covers genetic testing when it's a diagnostic test, meaning your doctor is using it to figure out or manage a condition you already have. It doesn't cover genetic testing done as general screening or to predict future disease in someone who's healthy. That distinction, diagnostic versus screening, is the whole ballgame.

The clearest example is cancer. Medicare covers a category of genetic test called Next-Generation Sequencing for certain cancer patients, and we'll walk through exactly who qualifies below. What it won't do is pay for a broad DNA panel you order out of curiosity, or a predictive genetic test for someone who's healthy.

What Genetic Tests Medicare Covers

The main pathway is a national rule called National Coverage Determination (NCD) 90.2, which the Centers for Medicare & Medicaid Services uses to cover Next-Generation Sequencing (NGS), a type of genetic test that reads large stretches of DNA at once. Under Part B, Medicare covers NGS as a diagnostic laboratory test for people with cancer when a treating physician orders it and the test runs in a certified lab.

There are two situations here, and they work a little differently.

Somatic testing reads the DNA of the tumor itself, the mutations a cancer picked up along the way. Medicare covers it nationally when the patient has advanced cancer, defined as recurrent, relapsed, refractory, metastatic, or stage III or IV, and the other conditions tied to an FDA-approved test are met.

Germline testing reads inherited DNA, the genes you were born with, to see whether a cancer runs in the family. Medicare added national coverage for germline NGS as a diagnostic test effective January 27, 2020, again when the specified conditions are met.

The common thread: both are diagnostic tests for someone who already has cancer, ordered by the doctor treating it.

What Medicare Doesn't Cover: Predictive and General Screening

Medicare draws a firm line at screening. It doesn't cover genetic testing done purely to predict risk or to screen a healthy person with no diagnosis driving it. That's the bucket that includes things like:

  • Direct-to-consumer DNA kits and ancestry-style health reports you buy on your own.
  • Predictive testing for a condition you have no symptoms of, ordered just to learn your risk.
  • Broad wellness gene panels marketed as preventive.

The reason traces back to how Medicare pays for lab work. According to Medicare.gov, Part B covers medically necessary diagnostic laboratory tests when your provider orders them, plus certain preventive tests and screenings. Genetic screening for a healthy person generally isn't a diagnostic test and isn't on Medicare's covered-preventive list, so it falls outside both.

If you've already had genetic screening done and paid out of pocket, that's usually why: it wasn't ordered as diagnostic care for a condition you have.

What a Covered Genetic Test Costs

So what does a covered genetic test actually run you? When the test qualifies as a diagnostic laboratory test your doctor orders, it's billed through Part B as lab work. If the same visit also involves other services, an office visit or a specialist consult, those follow standard Part B rules: you pay the annual deductible ($283 in 2026) and then 20% of the Medicare-approved amount.

If you have a Medicare Advantage plan instead of Original Medicare, your copays and prior-authorization rules can differ from what's described here, so confirm the details with your plan before the test is run.

How to Get a Genetic Test Covered

Every covered genetic test above runs through the same door: a treating physician has to order it, and it has to be medically necessary for your diagnosis. It comes from the doctor treating you, not from a test you arrange on your own.

A few practical steps:

  1. Talk to the doctor treating the condition, usually an oncologist for cancer NGS testing.
  2. Ask them to confirm the test meets Medicare's coverage rules for your specific situation before it's ordered.
  3. Check that the lab is certified, since NCD 90.2 requires the test be performed in a certified laboratory.

If you're not sure whether a test counts as diagnostic or screening in your case, that's exactly the question to put to your doctor's office before anything gets run.

Frequently Asked Questions

Does Medicare cover genetic testing for cancer?

Yes, in specific situations. Under NCD 90.2, Medicare covers Next-Generation Sequencing as a diagnostic test for people with advanced cancer, defined as recurrent, relapsed, refractory, metastatic, or stage III or IV, when a treating physician orders it and other conditions are met. It's coverage for people who already have cancer, not a screening test for healthy people.

Does Medicare cover inherited (germline) cancer gene testing?

Yes, when the conditions are met. Medicare added national coverage for germline NGS testing as a diagnostic test effective January 27, 2020, to look at the inherited genes that can carry hereditary cancer risk. As with the tumor-based test, a treating physician has to order it and it must be medically necessary for the diagnosis.

Will Medicare pay for a DNA test if I'm healthy and just want to know my risk?

No. Medicare covers diagnostic genetic tests, but it doesn't cover general or predictive genetic screening for healthy people. A direct-to-consumer kit or a predictive panel ordered when you have no diagnosis generally isn't covered, so you'd pay out of pocket.

Does a Medicare Advantage plan cover genetic testing?

Medicare Advantage plans cover the services Original Medicare covers, but they set their own copays and often require prior authorization. If you're in an Advantage plan, call the plan and confirm coverage and any approval steps before the test is ordered.

Learn More

MedicareDoes Medicare Cover Lab Tests?Does Medicare cover blood tests and lab work? Yes. Part B covers medically necessary lab tests your provider orders, and you usually pay $0 for them. MedicareWhat Medicare Actually Costs in 2026How much does Medicare cost in 2026? Part A, B, C, and D premiums, deductibles, and coinsurance, plus IRMAA and ways to lower your Medicare costs. MedicareMedicare Preventive Services: What You Get for FreeMedicare preventive services are mostly free: two wellness visits, screenings, and vaccines at $0, plus the billing trap that can turn free into a charge.

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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