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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that BRCA1 and BRCA2 testing consists of full sequence and duplication/deletion analysis. 
Genetic testing for a known mutation in a family may be limited to the known familial variant. 
 
The following indications for BRCA1 and BRCA2 testing are covered by Medicare: 
 
    A. Individual with breast, ovarian1, pancreatic, or prostate cancer from a family with a known deleterious 
BRCA1 or BRCA2 gene mutation 
    B. Individual with a personal history of ovarian1* cancer 
    C. Individual with a breast cancer diagnosis meeting any of the following criteria: 
        Diagnosed =45 y 
        Triple negative breast cancer (estrogen receptor (ER) negative, progesterone receptor (PR) negative, and 
human epidermal growth factor receptor 2 (HER2) negative) breast cancer diagnosed = 60 y 
        Diagnosed at 46-50 y with: 
            An additional breast cancer primary 
            =1 first, second, or third degree relative5 with breast cancer at any age, or 
            =1 first, second, or third degree relative5 with prostate cancer (Gleason score =7), or 
            An unknown or limited family history3 
        Breast cancer diagnosed at any age, and 
            =1 first, second, or third degree relative5 with breast cancer =50 y, or 
            =1 first, second, or third degree relative5 with ovarian cancer at any age, or 
            =1 first, second, or third degree relative5 with metastatic prostate cancer or pancreatic cancer at any 
age, or 
            =2 additional diagnoses of breast cancer at any age in patient and/or in close blood relative5, or 
            A first, second, or third degree male relative with breast cancer 
            For an individual of ethnicity associated with higher mutation frequency (e.g. Ashkenazi Jewish4) no 
additional family history may be required. 
        Male breast cancer 
    D. Personal history of prostate cancer (Gleason score=7) at any age with: 
        =1 first, second, or third degree relative5 with ovarian cancer at any age, or 
        =1 first, second, or third degree relative5 with breast cancer =50 y, or 
        =1 first, second, or third degree relative5  pancreatic cancer at any age, or 
        =1 first, second, or third degree relative5 with metastatic prostate cancer at any age, or 
        =2 first, second, or third degree relatives5 with breast cancer and/or pancreatic cancer and/or prostate cancer (any grad) at any age, or 
        Ashkenazi Jewish ancestry 
    E. Personal history of pancreatic cancer at any age 
    F. Personal history of metastatic prostate cancer (radiographic evidence of or biopsy-proven disease) 
    G. BRCA1/2 pathogenic mutation detected by tumor profiling on any tumor type in the absence of germline 
mutation analysis 
 
Includes fallopian tube and primary peritoneal cancers. BRCA  related ovarian cancers are associated with 
epithelial, non-mucinous histology. 
 
Two breast cancer primaries include bilateral (contralateral) disease or 2 or more clearly separate ipsilateral 
primary tumors either synchronously or asynchronously. 
 
Medicare will cover BRCA-testing for an adopted individual with breast cancer diagnosed =50 y, that is 
suspicious of being a BRCA-related cancer. Individuals with limited family history/structure, defined as fewer 
than 2 females first- or second-degree relatives having lived beyond age 45 in either lineage may also be 
eligible for BRCA gene testing. Similar to all testing, these situations require explanation of medical necessity 
for BRCA testing in the patient's medical record, and documentation of genetic counseling prior to BRCA 
testing. You can find this rule in the Local Coverage Determination (LCD) MolDX: BRCA1 and BRCA2 
Genetic Testing L36163. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.