Multiple (Breast, Ovarian, Colon, Pancreatic)
Genetic testing (BRCA, Lynch): when it’s covered
Last reviewed July 1, 2026
Genetic testing for cancer risk — BRCA1/BRCA2 (breast, ovarian, prostate, pancreatic risk), Lynch syndrome (colon, endometrial, other), and multi-gene panels — is one of the most powerful preventive tools in medicine. Testing is often 100% covered when you meet specific family history criteria. But if you don’t meet those criteria, testing is affordable out of pocket ($150-$300), and knowing your status can change your screening schedule for life.
The steps
The covered pathway: you’re covered if you meet NCCN or USPSTF criteria. For BRCA: a personal or family history of breast, ovarian, pancreatic, or prostate cancer, especially at younger ages, or Ashkenazi Jewish ancestry with any relevant family history. For Lynch: a personal or family history of colon or endometrial cancer, especially early-onset (before 50), or a family member with a known mutation. Full criteria at nccn.org.
The self-pay pathway: Color Health, Invitae, and MyGeneCounsel offer clinician-ordered panels for $250-$500. 23andMe offers a limited BRCA test for a subset of mutations for around $200 (Ashkenazi variants only. This is important; a "negative" 23andMe result does NOT rule out BRCA if you’re not Ashkenazi).
Genetic counseling should ideally happen BEFORE testing, not after. A counselor helps you decide which panel is right for you and what to do with the results. Most testing companies include free virtual counseling. If you’re going through insurance, most policies require pre-test counseling.
This applies when
- You have a personal history of cancer (especially breast, ovarian, colon, endometrial, pancreatic)
- You have a family history of these cancers, especially in first-degree relatives, especially before age 50
- You have Ashkenazi Jewish ancestry (1 in 40 carry a BRCA mutation vs. 1 in 400 in the general population)
- You have a family member with a known BRCA, Lynch, or related mutation
- You have a specific type of cancer where testing changes treatment (triple-negative breast, ovarian, metastatic prostate, pancreatic)
This doesn't apply when
- You have no personal or family history suggesting hereditary cancer risk
- You want testing out of curiosity without a clinical indication — insurers typically won't cover it
- You already had comprehensive genetic testing and are seeking repeat testing without new reason
- You're using direct-to-consumer testing without planning follow-up with a genetic counselor
Resources
National Society of Genetic Counselors: nsgc.org — find a genetic counselor.
Color Health: color.com — clinician-ordered BRCA + Lynch panels from $250.
Invitae: invitae.com — comprehensive multi-gene cancer panels, sometimes covered via research programs.
Basser Center for BRCA: basser.org — advocacy, research, and community for BRCA carriers.
FORCE (Facing Our Risk of Cancer Empowered): facingourrisk.org — support and advocacy for hereditary cancer risk.
If you're denied
If testing is denied for "not meeting criteria," get a genetic counselor to write a letter of medical necessity referencing NCCN guidelines. Most denials are reversed. If not, self-pay is affordable and the information is yours forever.
