Understanding Your Medicare Preventive Genetic Benefits
Under federal CMS guidelines, traditional Medicare Part B covers 100% of allowable costs for physician-ordered genetic testing when medical necessity is established—meaning $0 out-of-pocket copay or deductible for qualifying seniors.
1. Zero Out-of-Pocket Cost
When criteria are met, testing is billed directly to Medicare Part B. You will never receive a bill for covered services.
2. Physician Ordered & Reviewed
CMS mandates that all diagnostic genetic tests must be ordered by a licensed physician who confirms personal or family medical necessity.
3. No-Surprise-Billing Guarantee
If your Medicare plan or medical profile does not qualify, no swab kit is sent and zero charges are ever billed to you.
Will Medicare or Insurance Cover Your Test?
Compare coverage options across Medicare Part B, Medicare Advantage, commercial insurance, and direct self-pay.
| Platform Features & Benefits | RecommendedMedicare Part B | Medicare Advantage | Commercial / Self-Pay |
|---|---|---|---|
| Patient Cost Responsibility | Coverage may apply | Plan-dependent | Plan-dependent |
| Physician Review & Order Included | Yes (Network MD) | Yes | Yes |
| CLIA & CAP Certified Laboratory | Yes | Yes | Yes |
| 5-Minute At-Home Swab Collection | Yes | Yes | Yes |
| Prepaid 2-Way USPS Priority Shipping | Yes (Included) | Yes (Included) | Yes (Included) |
| Post-Test Physician Consultation | Yes (Included) | Yes (Included) | Yes (Included) |
| Coverage Review Before Shipment | Yes (Pre-Verified) | Yes (Pre-Verified) | Yes (Pre-Verified) |
Patient Cost Responsibility
Physician Review & Order Included
CLIA & CAP Certified Laboratory
5-Minute At-Home Swab Collection
Prepaid 2-Way USPS Priority Shipping
Post-Test Physician Consultation
Coverage Review Before Shipment
Insurance Review Before Shipment
Every test is reviewed by our insurance concierge before shipping. If coverage requirements are not met or plan details need additional review, we explain the next steps before any product or kit is sent.
When Does Medicare Part B Deem Testing Medically Appropriate?
Hereditary Cancer Screening (CGx)
Covered when an individual has a personal history of cancer or a significant multi-generational family history of breast, ovarian, colorectal, or prostate cancer meeting NCCN guideline thresholds.
Pharmacogenomics (PGx)
Covered for seniors taking multiple daily medications (polypharmacy), starting critical therapies (such as blood thinners or cardiac drugs), or experiencing adverse medication side effects.