BRCA testing looks for specific inherited changes in the BRCA1 and BRCA2 genes, providing important information about an individual’s risk for certain cancers. The final amount an individual pays for this testing is determined by their health insurance coverage and whether the test is deemed medically necessary according to established guidelines. Consequently, the out-of-pocket expense can range dramatically from nothing at all to several thousand dollars.
What BRCA Testing Identifies and Why It Is Recommended
The BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2) genes are normally responsible for producing proteins that help repair damaged DNA within cells. When a person inherits a harmful variant, or mutation, in one of these genes, this DNA repair function is compromised, significantly increasing their lifetime risk for several cancers. While most recognized for their link to breast and ovarian cancer, these mutations also elevate the risk for prostate and pancreatic cancers.
Medical guidelines, such as those published by the U.S. Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN), define the specific personal and family history criteria for who should be offered testing. Eligibility is generally based on a personal history of certain cancers or a close family history of cancers diagnosed at an early age. Specific ancestry, such as Ashkenazi Jewish heritage, is also a recognized criterion due to the higher prevalence of specific mutations in this population. Identifying at-risk individuals allows them to pursue aggressive screening or preventive measures, such as risk-reducing surgeries or chemoprevention.
The Full Cost Without Insurance
For an individual paying out-of-pocket, the list price for comprehensive genetic testing can be substantial. Historically, the cash price for a single-gene BRCA test from some major laboratories hovered between $3,000 and $4,000. However, the landscape has changed considerably with the advent of multi-gene panel testing and increased market competition.
The price variation depends on the specific laboratory and the breadth of the test being ordered. A targeted test focusing only on BRCA1 and BRCA2 may differ in price from a comprehensive multi-gene panel that screens for dozens of hereditary cancer genes. Today, some testing companies offer a much lower patient-pay price, with multi-gene cancer panels available for $250 to $299 for those who do not meet insurance criteria. This reduction reflects advancements in genetic sequencing technology and increased accessibility.
Navigating Insurance Coverage and Financial Aid
The cost of BRCA testing is significantly reduced once insurance is involved, provided the patient meets specific medical necessity standards. Testing is often covered as a preventive service under the Affordable Care Act (ACA) mandate. This mandate requires most private health plans to cover genetic counseling and the testing itself for women who meet the USPSTF criteria, often with no out-of-pocket costs like copays or deductibles.
Coverage is tied to meeting the guidelines, requiring a healthcare provider to use a risk assessment tool to determine if a woman is at increased risk based on family history or ancestry. If the test is ordered outside these preventive guidelines, such as for a man or a woman who does not meet the family history criteria, the cost is subject to the individual’s deductible and copayment structure. The patient is responsible for out-of-pocket expenses until their annual deductible is met, after which coinsurance applies.
Testing laboratories often provide patient assistance programs (PAPs) for those who are uninsured or underinsured. These programs help ensure that cost does not remain a barrier to medically appropriate testing. Some labs offer a maximum out-of-pocket cost of $200 to $250 for qualified patients based on income level or insurance status. Patients who are at or below the federal poverty level may receive the testing at no cost.
Steps to Obtaining a BRCA Test
Obtaining a BRCA test begins with a consultation with a healthcare provider, often a primary care physician or oncologist, who performs an initial risk assessment. If the assessment suggests an increased likelihood of a mutation, the next step is typically a referral for genetic counseling. Genetic counseling involves a detailed discussion of the personal and family history, the benefits and limitations of testing, and the implications of the results.
Once the decision to proceed is made, the test is straightforward, requiring either a blood sample drawn at a clinic or a saliva sample collected at home. The sample is sent to a specialized lab for DNA sequencing and analysis. Results are typically returned to the ordering provider or genetic counselor within two to four weeks, who then discusses the findings and necessary next steps for cancer risk management with the patient.