Medicare Will Cover Genetic Counseling Services Starting January 2027, Expanding Access to Risk Screening

The “Access to Genetic Counselor Services Act of 2025” is straightforward: it expands Medicare coverage to include genetic counseling services provided by qualified genetic counselors, effective January 1, 2027. Think of it as opening up a new lane on the healthcare highway for millions of seniors and disabled Americans who rely on Medicare.

The New Prescription: Professional Genetic Advice

Currently, if you needed specialized genetic advice—say, understanding your risk for certain hereditary cancers or determining if a medication will work for you based on your DNA—Medicare coverage has been limited. This bill changes that by defining “covered genetic counseling services” as services furnished by a qualified genetic counselor (GC). The key here is who qualifies: a GC must be licensed by the state where they practice, or if their state hasn’t caught up with licensure yet, they must be certified by the American Board of Genetic Counseling (ABGC). This ensures that only credentialed professionals are brought into the Medicare system.

What This Means for Your Family and Your Wallet

For the average Medicare beneficiary, this is a big deal for proactive health management. Genetic counseling isn’t just for rare diseases anymore; it’s increasingly vital for personalized medicine and risk assessment. For example, if you have a strong family history of early-onset heart disease or breast cancer, a genetic counselor can help you understand your risks and guide preventive action, potentially catching issues years before they become critical. Before this bill, many people had to pay out-of-pocket for this specialized advice.

The bill also includes necessary protections against surprise bills. It ensures that the current Medicare balance billing rules apply, meaning GCs can’t charge you the difference between what they bill and what Medicare pays. When it comes to payment, the bill sets the rate at 85 percent of the physician fee schedule amount that would apply if a doctor provided the service. While this payment structure is slightly lower than what a physician would receive, it provides a crucial new revenue stream for GCs and ensures the service is financially viable within the Medicare framework.

Implementation and the Fine Print

While the expansion of access is clearly beneficial, there are a couple of details worth noting. The bill gives the Secretary of Health and Human Services the authority to define the “related services and supplies” that are covered alongside the counseling. This is a bit vague right now, and how broadly or narrowly the Secretary interprets this definition will impact the comprehensiveness of the coverage. Too narrow, and GCs might struggle to provide holistic care; too broad, and it could lead to unexpected cost increases for the Medicare system.

Crucially, the bill clarifies that this new coverage doesn’t step on the toes of existing providers. Physicians and other healthcare professionals who are already authorized to bill Medicare for genetic counseling services can continue to do so. This means that access is expanded, not shifted, ensuring that Medicare beneficiaries can get this specialized advice from a broader range of qualified professionals starting in 2027.