3. Find Out if it is Covered By Insurance

The cost of biomarker testing depends on the test, the type of medical condition you have, and your health insurance. Some tests are covered by Medicare and Medicaid. If you are participating in a clinical trial, the trial may cover the cost of biomarker testing. Individual or employer-sponsored health insurers will usually cover biomarker tests when they are “medically necessary.” When deciding if a test is medically necessary, insurers weigh different factors to see if the test is appropriate and necessary to treat you.

• Single gene or multigene panel tests: Tests that look at one gene are more likely to be covered by insurance. Some panel tests are covered by insurance (e.g., private insurance, Medicare, Medicaid, etc.).
• Diagnosis or indication: Some biomarker tests are only covered for certain diagnoses. Others are only covered when you meet other criteria, like having a specific stage of cancer or prognosis.
• What is being tested (e.g., tissue from a tumor or liquid biopsy, usually from blood)?

Other factors that impact coverage:

• Is pre-authorization required? Many individual and employer-sponsored health insurers require you to get approval from them before you get a biomarker test.
• Some insurance policies list approved tests, while others do not. Even if a test is not named in your policy, it may be covered when “medically necessary.”
• Some companies require the use of specific tests, sold by specific companies.

As of 2026, half of states have passed laws requiring some form of insurance coverage for biomarker testing, and more states are considering similar bills. But these laws only apply to some plans in those states, such as Medicaid. Even if your state has not passed a law, insurance companies should still approve testing based on whether it’s “medically necessary.” For details on state laws and which plans they apply to, visit TriageHealth.org/StateLaws.