Living Well

Real Money: Genetic testing and a life-changing discovery (Part 1)

Gene research is at the cutting edge of medical science. Researchers are realizing that genes can tell a lot about your body - from the most effective ways to exercise, to the best way to manage your diet, to which diseases and conditions you're more likely to develop.

With that in mind, I decided to take a test in 2017 to determine whether or not I had a mutation on the BRCA gene. In short, such a mutation would put me at a severely increased risk for certain types of cancers. Shortly after submitting the test, I received a positive result.

Here's my story: How I found out, what I did to address it, and how I plan to pay for it all.

How I found out

Almost a year ago, I read an article in the New York Times about the BRCA gene, which is responsible for suppressing tumors that can cause breast and ovarian cancer. If you think you've heard of it before, it was probably in 2013 when Angelina Jolie wrote an essay about her decision to have a preventive double mastectomy because of her BRCA mutation. When I tell people I have a BRCA mutation, I usually preface it by asking if they remember Jolie's decision.

The Times article said that Jewish women had a one in 40 chance of having a mutation on the BRCA gene, and therefore being more susceptible to these types of cancers. I'm Jewish on both sides of my family, and the news hit home for one important reason - my grandmother died of ovarian cancer at 42.

I also used to work at a cancer agency. I learned how deadly ovarian cancer can be, and how difficult it was to go through treatment for even comparatively "mild" types of cancer. Every day I saw people suffering physically, mentally and financially, with no assurance that things would ever get better.

After reading the article, I asked my doctor about getting tested for the mutation. She didn't think I had enough family history to qualify, despite coming from a Jewish background, so she denied my request for a referral. I have very little family history to begin with, so this distinction seemed odd to me even at the time.

One testing option...

A few months later I discovered Color, an at-home DNA testing kit similar to 23andMe. Color offered a BRCA specific test for only $100. I'm a frugal person by nature and hated the idea of spending $100 out of pocket. Because my doctor didn't recommend the test, I couldn't even use tax-free funds to pay for it.

Providers only consider DNA tests as qualified medical expenses if a doctor recommends them. Usually, if the doctor suggests a BRCA test, it has to be done at their office. They can also write a letter of medical necessity if you want to purchase a DNA test for home use using FSA funds.

A few weeks after submitting my saliva sample to Color, I got my results: I had a mutation on my BRCA1 gene. In short, that means I have an 81% lifetime risk for breast cancer and 54% lifetime risk for ovarian cancer.

My head started spinning and my stomach sank. Thankfully, I was on the phone with one of Color's professional genetic counselors. She told me my next steps were an appointment with a clinical geneticist, who would then refer me to an OB-GYN and breast surgeon.

She also said I'd need a breast MRI, vaginal ultrasound and a specific blood test every six months until I got my surgeries. Most BRCA-positive women get their ovaries and Fallopian tubes out once they're finished having kids, or before age 35.

That may sound extreme, but ovarian cancer currently has no effective screening method. A vaginal ultrasound will usually only pick up cancer once it's advanced, and the blood test has a high false-positive and false-negative rate. In short, by the time you get diagnosed it might be more severe than expected.

Next steps...

The testing was only the beginning of my BRCA journey. Next, I had to figure out how to pay for all the additional tests I would need - and especially how to cover the cost of surgery. Be sure to check back to see how this journey is affecting my health and financial planning for the next year.

Eligible testing and diagnostics

LetsGetChecked Basic 3 STD At Home Test

The home STD test detects the presence of the 5 most common infections.

$120.00

EZ DETECT - Early Warning Signs of Colorectal Disease

Simple Home Test for detecting the early warning signs of colorectal disease.

$8.99


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Whether you budget week-to-week, or plan to use your FSA for bigger things, our Real Money column will help you maximize your flex spending dollars. Look for it every Tuesday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram and Twitter.

Living Well

Real Money: Cancer prevention, screenings and FSAs

One of the most important components of preventative health care is screening for life-threatening diseases like cancer. And when it comes to beating cancer, detecting and treating it early on can dramatically increase your chances of survival.

The goal of these preventative screenings is to catch any signs as early as possible, which gives your medical team the best chance of effectively treating - and defeating - the disease.

September and October represent awareness months for several types of cancer, and that means prevention. Since the ACA has ruled that preventive care is covered by insurance, additional costs don't often occur when it comes to cancer screenings. If there are any additional costs, however, they should be eligible for FSA reimbursement.

(Please note: All plans are different. Be sure to check with your administrator to see what your plan will allow.)

What kind of screenings are done?

Since there are so many different kinds of cancer, there are a variety of different screenings that can be done as a part of preventative care. Depending on factors like age, gender, and family history, your doctor will determine when and how often you should be screened.

Self-screening is important too, and your doctor will advise you on what to look out for and when you should report to a medical professional for further tests. Some common examples of cancer screenings include:

Skin cancer

Skin cancer is the most common type of cancer in the United States, as well as amongst young people. So doctors recommend that you regularly check your skin for irregular growths and schedule an appointment right away if you notice anything of concern.

People who spend a lot of time in direct sunlight are at an even higher risk for the disease, so this is even more important to do if your job or recreational activities have you outside on a regular basis.

To test for skin cancer, a dermatologist will examine your skin. If it's suspected that an area might be cancerous, a biopsy of the tissue will be conducted. Any costs associated with these tests will be eligible for reimbursement.

Breast and gynecological cancer

For women, breast cancer and ovarian cancer screenings are an important part of regular preventive care. It's recommended that healthy women with few risk factors begin getting screened regularly at age 40, but a doctor may recommend that these screenings begin earlier if you have certain risk factors.

If you have a family history of breast or ovarian cancer, your doctor may recommend a BRCA test, which is a blood test that checks your DNA for mutations in certain genes which can indicate whether you're likely to develop cancer. Unlike other genetic tests, the BRCA screening is done solely for medical purposes, so it's eligible for reimbursement without a Letter of Medical Necessity (although we always advise that you check on your FSA details with your plan administrator or HR department to ensure that your plan covers all qualified medical expenses).

Other screenings, like mammograms and digital infrared thermal imaging, are also eligible for reimbursement.

Prostate cancer

Men, on the other hand, should be screened for prostate cancer. Most medical professionals recommend that screenings begin regularly by age 50, but may also suggest that screenings begin earlier if certain risk factors are present.

To screen for prostate cancer, your doctor may recommend a Digital Rectal Exam, which identifies abnormalities in the gland, as well as a Prostate Specific Antigen (PSA) test, which is a blood test that measures PSA levels. Elevated levels can be a sign of cancer or an enlarged prostate. If your insurance doesn't cover any of the costs associated with these types of screenings, they should be eligible for reimbursement.

Colon cancer

Colonoscopies are done to determine whether or not polyps are present in the colon. Polyps can evolve into malignant tumors, so detecting them early on is important. Depending on risk factors, most doctors recommend that people start getting screened for colon cancer on a regular basis by age 50.

Since a colonoscopy is a preventative screening, it should be covered by your primary health insurance plan. Any additional costs will be eligible for FSA reimbursement.

Home medical essentials

Nima Gluten Sensor - Starter Kit

Know if your food is really gluten-free. Put food into a test capsule, put the capsule in the sensor, and push start. See your result in 2-3 min!

Caring Mill Digital Wrist Blood Pressure Monitor

A lightweight and compact device that is easy to use on the go and to travel with.

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Whether you budget week-to-week, or plan to use your FSA for bigger things, our weekly Real Money column will help you maximize your flex spending dollars. Look for it every Tuesday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram and Twitter.