New Medicare Rule Covers Genetic Testing and Preventive Surgery for Hereditary Cancer Risk

The “Reducing Hereditary Cancer Act of 2025” is basically giving Medicare a much-needed upgrade when it comes to catching cancer early in high-risk individuals. For anyone with a family history of cancer, or a personal history that raises red flags, this bill is a big deal because it takes proactive prevention from a nice-to-have to a covered necessity under Medicare Part B.

The Fine Print on Genetic Testing

Under Section 2, Medicare will now cover germline mutation testing—that’s the specific test looking for inherited cancer risks like BRCA—if you have a personal or family history that suggests you might need it. This is a game-changer for older adults who previously faced significant out-of-pocket costs for this crucial diagnostic step. The catch? The testing must follow established, evidence-based clinical guidelines from major groups like the National Comprehensive Cancer Network. Here’s where the policy gets real: if different expert groups disagree on coverage, Medicare contractors are instructed to choose the least restrictive guideline. That’s a win for patients, ensuring broader access rather than narrower denials. However, Section 2 also explicitly states that this testing will only be covered once per individual. If new technology emerges or your risk profile changes down the line, a repeat test under this provision is currently off the table, which could be a significant hurdle for long-term risk management.

Covering the Ultimate Preventive Measure

Section 3 addresses high-risk preventive surgeries. Think of someone who tests positive for a high-risk gene mutation and chooses to have a prophylactic mastectomy or oophorectomy—surgeries designed to drastically reduce the chance of cancer before it starts. Previously, Medicare often struggled to cover these, as they weren't strictly “treating an illness.” This bill fixes that by reclassifying these specific, guideline-based risk-reduction surgeries as “reasonable and necessary for treatment of illness.” This means if you meet the criteria and the surgery is recommended to lower your cancer risk, Medicare coverage kicks in the day this Act becomes law. This removes a massive financial barrier for individuals who know they are high risk and want to take the most aggressive preventive action.

More Frequent Screenings for High-Risk Folks

If you already know you have a hereditary cancer gene mutation, Section 4 is designed just for you. Right now, standard Medicare rules often limit how frequently you can get screenings like mammograms, breast MRIs, or colonoscopies. This bill mandates that Medicare must relax those frequency limits for individuals with known high-risk mutations. This means you can get screened more often—at least annually—if clinical guidelines recommend it. For someone with a BRCA mutation, for example, this means consistent, timely surveillance that drastically improves the chances of catching cancer early, aligning Medicare policy with the best available medical science for high-risk patients. This change ensures that once you have the genetic information, you can actually use it to stay ahead of the disease without fighting the insurance bureaucracy every year.