Her Doctor Will Order a $949 Blood Test That Screens for Multiple Cancers. Medicare Will Pay $0 Toward the Test, Leaving Her With the Entire Bill Before Any Coverage Decision in 2029
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A 70-year-old woman has kept up with her mammograms and colonoscopies. Now her doctor suggests one more step: a blood draw that looks for signs of dozens of cancers at once. The test is Galleri, from Grail (NASDAQ:GRAL | GRAL Price Prediction), and its list price is $949. The test is not covered by Medicare. A new federal law makes coverage possible starting in 2029, but its age rules may leave her out for good.
The FDA hasn’t approved the test either, though it is getting closer. On September 23, 2026, an FDA advisory panel voted six to four in favor of Galleri’s effectiveness, seven to two with one abstention that its benefits outweigh its risks, and unanimously in favor of its safety. Grail reportedly expects the FDA to decide by early Q1 2027.
Why Medicare Won’t Pay the $949
Galleri reads DNA that tumors shed into the blood. It looks for cancer-specific methylation patterns and, when it finds a cancer signal, predicts which organ the signal came from to guide the diagnostic workup. Its main appeal is reaching cancers that have no recommended screening today, including pancreatic, esophageal, ovarian and liver cancer.
Grail designed the test to be used in addition to guideline-recommended screenings. That means her mammogram and colonoscopy schedule stays exactly as it is. Grail sells Galleri today as a laboratory-developed test that requires a prescription and is not yet FDA-approved. Until Congress acted, Medicare lacked a specific coverage pathway for multi-cancer early detection screening tests.
The 2026 standard Part B premium is $202.90 a month, so one Galleri test costs about 4.7 months of Part B premiums.
Congress Opened the Door for 2029
The Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act became law on February 3, 2026, as part of a bipartisan spending package. Under the law, Medicare coverage cannot begin until Jan. 1, 2029. Two conditions also have to be met: the FDA must approve or clear the test, and CMS must decide through its national coverage process that it is reasonable and necessary for Medicare patients.
Her real problem is the age phase-in. Under the law Congress enacted, Medicare cannot pay for the test for anyone 65 or older as of January 1, 2029. That cutoff rises by one year annually, reaching 66 in 2030 and 67 in 2031.
The problem is that she keeps getting older, too. Each year Medicare raises the age cutoff, she ages another year. At 70 today, she’ll still be too old to qualify in 2029, 2032 or even a decade later. There is one way that could change. If the U.S. Preventive Services Task Force gives the test a top rating of A or B, the age restriction disappears. Otherwise, even those who qualify can get only one covered test every 11 months.
What Happens If She Wants the Test Now
She pays out of pocket, but she doesn’t have to pay list price. Grail offers promotional pricing, and the amount patients pay can vary by provider. Grail lists the test at $949, but says many doctors and health systems offer it for $799 or less.
Other coverage may help:
- TRICARE: Duly reports that TRICARE plans cover Galleri for eligible patients ages 50 and up. A military retiree should check before paying cash.
- Employer or spouse’s plan: If she or her spouse still has active employer coverage, a private insurance company may cover the test even though Medicare does not.
- Grail’s REACH study: This clinical study includes Medicare beneficiaries receiving Galleri alongside their usual care. She can ask whether enrollment remains open and which costs the study covers.
A positive result can bring larger costs than the test itself. Grail reports a false-positive rate of 0.4%, but any cancer signal starts a diagnostic workup, often with imaging and specialist visits. Before the blood draw, she should ask her doctor which tests a positive result would trigger and whether each one would be charged as diagnostic. Diagnostic follow-up runs through her Part B deductible of $283 in 2026, plus coinsurance if she has no Medigap plan.
FDA Approval Won’t Guarantee Coverage
An FDA approval in early 2027 would move Galleri closer to possible Medicare coverage. Payment would still require a favorable determination from CMS, and the new benefit cannot begin before 2029. Cost pressures add another layer of concern for beneficiaries (we mapped the premium surcharges and coverage gaps most retirees miss in a free guide here: Medicare’s Hidden Bills).
If she is 70 or older, she should treat Galleri as a cash expense for the foreseeable future. That means shopping for the lowest price, checking TRICARE or employer coverage first, and mapping out the follow-up costs with her doctor before the test. The development that could change her answer is a Task Force A or B rating, which would remove the age cap. Until that happens, a 2029 start date won’t help her.
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Gerelyn Terzo is the author of dividend investing handbook "Dividend Investing Strategies: How to Have Your Cake & Eat It Too." A veteran financial journalist, she covers agri-finance for outlets like Global AgInvesting and the broader stock market and personal finance for 24/7 Wall Street. She began at CNBC and later helped launch Fox Business in New York. Gerelyn currently resides in Woodland Park, Colorado and dabbles in nature photography as a hobby.
