Millions of people use at-home genetic testing to learn about their ancestry, health traits, possible disease risks, and more. Kits from sites such as Ancestry and 23andme are surging in popularity. More than 26 million people used an at-home genetic test as of 2019, and that number has undoubtedly grown since then.
These tests give intriguing information about medical risk factors, health traits, and non-medical traits — such as eye color or ancestry — which can help you make better health decisions. Understanding your ethnic origins and genetic health risks could guide your wellness choices and may also influence your health insurance coverage.
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What Is Genetic Testing and Genetic Counseling?
Genetic testing looks for genetic changes or variations related to health traits and conditions. The tests come in clinical and direct-to-consumer (DTC), or at-home kits. A physician orders a clinical genetic test for a specific medical reason or family disease history. The lab or a genetic counselor reviews the test’s results alongside other information, including your unique lifestyle, other risk factors, or evidence of disease.
An at-home genetic test uses a saliva sample to determine your disease risks and your ancestry. But these at-home kits cannot completely guarantee your disease risk or ethnicity. DTC tests will not determine whether you will get a disease or diagnose you with a disease, and many factors beyond your genetics influence your chances.
At-home genetic tests are sent only to you — not your doctor or insurance company. Relatively inexpensive, the test reveals dozens of potentially inheritable conditions, diseases, and traits. Some are fun (such as eye color). Others are more serious, such as whether you carry a gene implicated in possibly developing Alzheimer’s disease.
Some people choose to do an at-home test for potential disease risk because family members were diagnosed with a disease. Conversely, other consumers are unaware of biological family health history and want insights into ancestry and chances of risk.
You might also want an at-home test out of curiosity or to be proactive about your health. Or if you’re planning to get pregnant and are concerned you’re a carrier for an inherited disease. However, remember that newborn screening for genetic conditions is typically covered by health plans under the Affordable Care Act.
Potential downsides of genetic testing include:
- Unexpected family relationships revealed
- Potential risk factors for serious disease can be upsetting
- Confusion about what results mean
The science of genetic testing is still evolving, so you need to weigh any results against the limits of an at-home test (more on this in a bit).
What Can Genetic Testing and Counseling Find?
At-home genetic testing can discover your increased risk of certain diseases and conditions, including your risk of breast or colorectal cancer. Other findings that could reveal:
- Physical Traits: Such as eye and hair color
- Health Predisposition: Whether your DNA includes gene variants that could lead to conditions such as type 2 diabetes or high cholesterol
- Carrier Status: If you carry certain genes that you could pass on to your children
- Health Reports: If you’re likely to have allergies to certain animals or seasonal allergies
Your actual risk for any of these conditions relies on many factors, including diet, exercise, ethnic background, environment, and medical history. For this reason, speaking with your physician or a professional genetic counselor can help you better assess risks.
For example, suppose the at-home genetic test noted that you’re at higher risk for lactose intolerance. You visit your doctor and share your results. Your doctor performs a physical exam and orders a test to see how you diagnose lactose. This test requires you to drink a lactose-containing formula, then measures how well you processed the lactose. The test shows you are lactose intolerant, and your physician works with you to modify your diet.
But you would not want to stop ingesting all foods containing dairy based on at-home kit results, which could lead to nutritional deficiencies — or you missing out on foods you enjoy without confirming the results.
Are At-Home Genetic Kits Accurate?
At-home genetic tests can only estimate whether you’re at higher risk of having or developing a disease, not whether you have a disease. FDA-approved or FDA-authorized tests have to meet requirements for quality and accuracy. However, some at-home tests may not be as accurate as traditional lab-based genetic tests, even if FDA-approved.
Some tests may be wrong due to a testing error or because the testing misses some genetic factors. This could result in a false positive, where it seems like you’re at risk of a disease but are not) or a false negative, where it looks like you’re not at risk, but you are. Some health-related tests may be FDA-approved, while others depend on the company’s research.
For this reason, any disease diagnosis must be confirmed using clinical genetic testing. And even if an at-home kit says you are not at risk for a disease, you should not skip your doctor’s recommended screenings.
What Can Your Ancestry Tell You About Your Health?
Genetic ancestry testing looks at your chromosomes (if male), DNA, and variations in your genomes. This testing can reveal family relationships and correlations to ethnic databases. Ethnicity estimates can vary widely between testing companies due to intermixed ethnic groups, fewer genetic collections from smaller ethnic populations, or using different genetic databases.
Genetic ancestry testing can provide clues for further research. For example, some ethnic groups have a much higher chance of carrying a harmful inherited gene mutation in BRCA1 and BRCA2, genetic abnormalities that can lead to breast cancer. If you discovered you have Ashkenazi Jewish, Norwegian, Dutch, or Icelandic heritage, you might want to get tested for these genetic mutations. Of course, disease risk does not just rely on ethnicity, but other risk factors explored earlier.
Does Health Insurance Cover Genetic Counseling and Testing?
Your health insurance plan may cover clinical genetic testing and counseling if recommended by your doctor. Ask your insurance company about coverage before testing, and review any applicable deductibles and copays.
Some consumers pay out of pocket for genetic testing or get a direct-to-consumer test. Your health insurance likely will not cover at-home genetic testing kits. But you may be able to use Flexible Spending Account (FSA) or Health Savings Account (HSA) funds for some health testing. However, ancestry testing likely would not be covered.
How Your Genetic Results Can Impact How You Shop For Health Insurance
If your genetic testing reveals a potentially high risk of a disease, you’ll need to decide whether to get genetic counseling and discuss the results with your doctor. Your insurance could cover disease prevention, testing, management, and treatment.
If you face higher chances of disease risk, you might ensure your health insurance covers preventive screenings. For example, if you’re at higher risk for breast cancer as a BRCA1 carrier with a family history of breast cancer — you’ll want to ensure frequent and early mammograms are available to you.
Finally, it’s important to note that your genetic test results cannot be used against you by your health insurer.