Genetic Services Insurance FAQs
Answers to the most commonly asked questions regarding genetic counseling and insurance coverage
Families undergoing genetic counseling are often concerned about insurance coverage. Following are answers to frequently asked questions.
Will insurance cover genetic testing and counseling?
Many insurance companies provide coverage for genetic testing for people who have a personal history or strong family history of cancer or other genetic conditions. Genetic counseling may also be covered by your insurance plan, Medicare or Medicaid, depending on your medical situation and benefits. Check with your insurance company for specific benefits information.
What if my insurance plan does not cover genetic testing or counseling?
Your genetic counselor can help look into your insurance coverage and determine if you are eligible for other forms of financial assistance or if you quality for research testing. Payment plans may also be an option for qualified patients.
Will insurance discriminate against me or my family for genetic findings?
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law protecting people who are part of a group health plan, such as health insurance provided through an employer or union. According to HIPAA:
- genetic information cannot be considered a pre-existing condition
- genetic information cannot be used to deny or limit insurance coverage
- insured individuals cannot be charged more for health coverage than others in the same health plan based on genetic testing results.
For self-insured individuals, state laws offer similar protection. Wisconsin has a strong history of laws protecting an individual's genetic information.
Genetic Information Nondiscrimination Act (GINA)
In May 2009, a law went into effect called the Genetic Information Nondiscrimination Act (GINA), which protects predictive genetic information by:
- preventing people from being refused employment or health insurance coverage based on genetic testing results
- making sure genetic testing results are kept private
- preventing insurance companies from using genetic information to decide what group and individual insurers pay for health insurance or if they are eligible for coverage.
Life, disability or long-term care insurance
There are currently no laws protecting life, disability or long-term care insurance from genetic discrimination. While cases of insurance discrimination based on genetic testing for cancer are extremely rare, people undergoing genetic testing should consider how a positive test result might affect their insurability.
If you think genetic counseling is right for you, talk to your primary care doctor about a referral to the Affinity Genetic Counseling program.
