Horizon test and pregnancy: Coverage, accuracy, pricing, and more

Preparing for a family can mean more than just planning dates or logistics — for many parents, it’s about understanding genetic health and potential risks that might affect their baby. The Horizon test by Natera is a carrier screening tool designed to provide insight into inherited conditions that could be passed on.

Many people consider taking the Horizon test before pregnancy to gain clarity on their genetic risks and make informed decisions. Others learn about the test during pregnancy, when knowing carrier status can help guide further prenatal care.

In this article, we’ll explain what the Horizon test is, how it works, and what conditions it screens for. We’ll also cover key factors like accuracy, timing, and cost, so you can decide if it fits your family planning needs, whether you’re planning a baby or already expecting.

What is the Horizon test?

Horizon is a carrier screening test developed by Natera. It uses advanced next-generation sequencing (NGS) technology to analyze your DNA and identify whether you carry genes linked to inherited recessive or X-linked conditions.

This means it detects conditions that could be passed to your child if both parents are carriers, or if the mother carries a gene on the X chromosome.

The test screens for a broad range of inherited conditions, including common disorders like cystic fibrosis and spinal muscular atrophy, as well as rarer genetic diseases such as Canavan disease and Usher syndrome.

How does the Horizon test work?

The Horizon test starts with choosing the right screening panel for your needs. Once ordered by your healthcare provider, the process typically looks like this:

1. Provide a sample: You'll give a saliva or blood sample — both are equally accurate, so it's up to your comfort and preference.

2. Sample is analyzed: Your sample is sent to a certified lab, where specialists screen your DNA for genetic markers linked to inherited conditions.

3. Get your results: Results are usually ready in about 15 days and delivered to your healthcare provider, who’ll help you understand what they mean and what to consider next.

Taking the Horizon test fits into both pre-pregnancy and pregnancy planning. If you're already pregnant and found to be a carrier for certain conditions, your partner may be advised to undergo screening too, especially for recessive conditions. For X-linked conditions, only the mother typically needs to be tested.

Horizon test: 4 factors to consider before deciding

Before going through Horizon carrier screening, it’s important to understand some key factors that can guide your choice. These include:

1. Genetic conditions screened

2. Test eligibility and timing

3. Accuracy

4. Pricing and insurance coverage

1. Genetic conditions screened

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Horizon offers 12 different panel options, each screening for a specific set of genetic conditions. These panels range from smaller options that cover four conditions to fully custom panels that screen for 613 conditions.

The panels focus primarily on autosomal recessive and X-linked conditions, meaning both parents typically must carry a variant for the baby to be at risk, except in cases of X-linked conditions, where only the mother’s variant matters.

For example, here’s what one of the company’s most popular panels, Horizon 14, covers:

1. Alpha-thalassemia

2. Autosomal recessive polycystic kidney disease

3. Beta-hemoglobinopathies (including sickle cell anemia)

4. Canavan disease

5. Cystic fibrosis

6. Duchenne/Becker muscular dystrophy

7. Familial dysautonomia

8. Fragile X syndrome

9. Galactosemia

10. Gaucher disease

11. Medium chain acyl-CoA dehydrogenase (MCAD) deficiency

12. Smith-Lemli-Opitz syndrome

13. Spinal muscular atrophy

14. Tay-Sachs disease

It’s important to note that Horizon doesn’t screen for dominant conditions caused by a single variant, such as Huntington’s disease or Marfan syndrome. It also doesn’t detect microdeletions, monogenic diseases outside its panels, or fetal sex. If you’re interested in chromosomal testing or fetal DNA analysis, Natera’s Panorama test may be more appropriate.

Choosing the right panel depends on your family history and ethnicity, so discussing your background with a genetic counselor or doctor can help tailor the screening to your needs.

Bonus read — Check out our Panorama vs. Horizon test comparison to learn how these Natera tests differ.

2. Test eligibility and timing

Horizon would typically be recommended to you if:

• You’re planning a pregnancy and want to understand your genetic risks ahead of time.

• You’re already pregnant, especially in the first trimester, and want to assess whether your partner should be tested.

• You’re using a sperm or egg donor, where screening is often required to minimize the risk of passing on inherited conditions.

• You have a family history of a genetic condition, and your provider recommends broader or targeted screening.

While Horizon can be taken at any point, testing before conception offers the most flexibility if you’re found to be a carrier. It allows you to consider options like IVF with preimplantation genetic testing (PGT), or using donor sperm or eggs.

Even during pregnancy, Horizon can still provide valuable guidance. For example, it might inform your decision to pursue prenatal diagnostic testing, such as chorionic villus sampling (CVS) or amniocentesis, based on your carrier status and your partner’s results.

3. Accuracy

Source: luvqs

Horizon claims it has high detection rates. The company uses next-generation sequencing technology to screen your DNA for specific inherited variants. In clinical use, this technology has been shown to detect common types of genetic changes with accuracy rates over 99%.

That means if Horizon reports that you carry a variant linked to a condition in your panel, the result will likely be correct from a technical standpoint.

But even with strong performance in the lab, there are a few important things to keep in mind when interpreting your results:

• Horizon is a screening test, not a diagnostic one: It tells you whether you're a carrier for certain conditions and not whether your baby will inherit them. If both you and your partner are carriers for the same condition, there may be a 25% risk to the baby, but further diagnostic testing (like amniocentesis) would be needed to confirm the outcome.

• Results are limited to what’s on your selected panel: Horizon screens for up to 613 conditions, depending on the panel, but your results only reflect the ones screened. If a condition isn’t included in your panel, it won’t be reported even if you carry a gene variant associated with it.

• Some results might include variants of uncertain significance (VUS): This means the test found a change in a gene, but experts aren't sure whether it increases risk. These cases are rare, but they can create ambiguity.

• It doesn’t account for non-genetic factors: Horizon only looks at inherited variants, not spontaneous genetic changes, environmental influences, or other health factors.

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4. Pricing and insurance coverage

The cost of the Horizon test can vary widely, and many patients find this part confusing. Two main factors influence the price: the size of the panel you choose (more conditions usually mean a higher cost) and whether your insurance covers the test.

You have two payment options:

1. Insurance billing: Natera submits the claim to your insurer. If covered, you may pay little to nothing beyond a copay. But if your claim is denied or your deductible is high, bills can run from several hundred to over a thousand dollars.

2. Self-pay: Pay a flat rate upfront, which depends on the panel size — generally $249 for smaller panels and up to $449 for larger ones.

According to Natera, many patients with in-network insurance pay minimal out-of-pocket costs. However, high deductibles or limited coverage can lead to unexpectedly large bills.

Natera’s Price Transparency Program updates your estimated cost once your sample arrives. If costs exceed a certain threshold, they’ll contact you to confirm whether to proceed with insurance billing or switch to self-pay. If you don’t respond, billing continues through insurance.

User experiences echo this unpredictability. For example, one user shared on Reddit how insisting on the self-pay option capped their cost at $150, avoiding a $7,000 bill:

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Many others have reported surprise charges, especially when claims were denied or processed out-of-network.

Given these uncertainties, reviewing your insurance coverage and payment options carefully before testing to avoid unexpected expenses is wise.

Verdict — Should you take the Horizon test?

If you're planning a pregnancy or already expecting, the Horizon test can offer valuable insights into potential genetic risks. It’s a well-established carrier screening tool that helps identify whether you or your partner are carriers for certain inherited conditions — and for many families, that’s a crucial first step.

But like any test, it has its limitations. Here’s a quick summary of where Horizon shines and where it falls short:

Many parents-to-be see carrier screening as an important step toward understanding their genetic risks. Yet, Horizon’s limitations in panel size, pricing transparency, and access may leave some wanting a more comprehensive, straightforward, and convenient solution.

Nucleus offers expanded carrier screening through whole-genome sequencing (WGS), covering over 900 conditions with fixed upfront pricing. This clinical-grade test is physician-approved, making it available directly to consumers without needing a separate doctor’s visit. Plus, unlike Horizon, it integrates genetic data with lifestyle and environmental factors for a more complete picture of your family’s health.

Get a full picture of your genetic health with Nucleus

If you're looking for deeper insight into your family’s genetic health, Nucleus offers more than standard carrier screening. It uses whole-genome sequencing to screen for over 900 inherited conditions, helping you identify risks that might go undetected with Horizon.

Nucleus was designed with future parents in mind. It supports family planning through:

• Easy-to-understand reports: They’re written in plain language and include practical insights, so you know what your results mean and what steps to consider.

• Upfront, fixed pricing: No surprise bills — what you see at checkout is exactly what you pay.

• No clinic visits required: Just order the kit, provide cheek swabs, and send them back — Nucleus takes care of the rest.

• Guidance included: If you’d like to talk through your results, genetic counseling is available through Nucleus’s partnership with SteadyMD.

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Get started with Nucleus

Getting started with Nucleus is easy:

1. Sign up for Nucleus

2. Provide your personal information

3. Place your order

Once your kit arrives, follow the instructions provided with the kit to collect your sample and ship it back with the prepaid label.

Nucleus’s at-home carrier screening test costs $499, or $798 for both partners. Nucleus is fully HIPAA-compliant and CAP/CLIA certified, so you can trust that your results are secure, private, and clinically reliable.

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