Does Medicare cover 4Kscore test?

Medicare covers a 4Kscore® test in specific circumstances when it is deemed medically necessary. A 4Kscore® is covered by Medicare Part B after an abnormal result is returned from the common prostate cancer screenings. The 4Kscore® test Medicare coverage may have out-of-pocket expenses, but Medicare Supplement can help cover coinsurance and deductibles.

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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Jan 7, 2021

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The Highlights

  • Medicare will cover the 4Kscore® test for prostate cancer under Medicare Part B
  • The test must be deemed medically necessary in order to be covered by Medicare
  • Prior prostate cancer screenings, including blood tests and a digital rectal exam, will be done before a 4Kscore®

Does Medicare cover a 4Kscore® test? Medicare covers a 4Kscore® test for patients who meet specific criteria. A 4Kscore® test is a diagnostic tool for prostate cancer that is used after there has been an abnormal prostate-specific antigen (PSA) or digital rectal exam (DRE) test result. Not all health insurance plans will cover this test, and as with Medicare, there are often specific requirements. There may be an out-of-pocket cost associated with the test. Medicare Supplement or Medicare Advantage plans can help to cover some of these costs.

If you’re looking to reduce your out-of-pocket expenses for a 4Kscore® test through Medicare, enter your ZIP code to compare rates on supplemental and Medicare Advantage options.

Does Medicare cover the 4Kscore® test?

According to Medicare.gov, prostate cancer screenings are covered by Medicare. There are two common screenings that are covered as initial steps towards diagnosing prostate cancer. An abnormal finding on either of these screenings can warrant the use of a 4Kscore® to get further information. Medicare coverage for the test was approved in November of 2019.

The two common screenings are:

  • Prostate-specific antigen (PSA)
  • Digital rectal exam (DRE)

Both of these are covered by Medicare on an annual basis. While the PSA test, a blood test, is covered in full, the DRE has a 20 percent coinsurance and your Part B deductible applies.

Medicare will cover the 4Kscore® test when it is deemed to be medically necessary, based on specific findings in previous tests and only in men over the age of 45.

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What is the cost of a 4Kscore® test with Medicare?

Medicare doesn’t list the test on its website, which may be due to the fact that it’s a relatively new test. As a diagnostic test, the 4Kscore® test will likely be subject to Part B coinsurance of 20 percent and to the Part B deductible as well.

If you have a Medicare Advantage plan, you will need to check with your provider to find out what is covered and what your out-of-pocket costs will be. For those with Original Medicare, a Medigap (Medicare Supplement) plan can cover some or all of the coinsurance and deductible amounts to reduce the out-of-pocket expense.

Does Medicare cover a 4Kscore® test? The Bottom Line

Medicare will cover a 4Kscore® for prostate cancer when it is found to be medically necessary based on the results of previous screenings. It is covered for men 45 or older who meet the criteria. There may be out-of-pocket costs for the test.

To compare rates for Medicare Advantage or find a Medicare Supplement plan that will cover your expenses for a 4Kscore® test, enter your ZIP code now.

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