There are many medical tests that can help in not just knowing if you are at high or low risk of developing a medical condition, but also in making an early treatment plan. One such test is called the Oncotype DX test. There are many types of this test, two for breast cancer and the other for prostate cancer. 

If this is a test you are considering, you probably want to know “does Medicare cover Oncotype DX test?” In this article, we answer that question in clear, plain English. You will also find the average costs of the Oncotype DX test and other helpful info.

Does Medicare Cover Oncotype DX Test?

The short answer is yes; Medicare will cover the cost of the Oncotype DX test. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Oncotype DX test. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for the Oncotype DX test. Parts A and B provide coverage for all types of Oncotype DX tests that will be discussed here. 

While an Oncotype DX test is a little expensive, Exact Sciences created the Genomic Access Program, or GAP, to help patients get their healthcare and medical insurance to cover the necessary tests. The GAP team can do the following to help your Oncotype DX test be more affordable:

  • Contact the patient’s insurance (in this case Medicare)
  • Cooperate with clinicians to get prior authorization from the patient’s healthcare and medical insurance company 
  • Bill the patient’s insurance company directly when it is possible
  • Process the claim after the test if needed
  • Assist in the appeal process if the patient’s claim is denied (however, the patient’s consent is needed first)

Part C Coverage for Oncotype DX Test

Medicare Advantage plans (Medicare Part C) also provide coverage for Oncotype DX tests. Advantage plans have to cover all the treatments, tests, exams, etc. Original Medicare covers. But these plans also provide coverage for things that Parts A & B do not. Each Part C plan differs as far as what additional things they cover and how much it costs plan members.

How Much Do Oncotype DX Tests Cost?

An Oncotype DX test usually costs about $4,000. This price is unlikely to vary greatly.

What Are The Three Types Of Oncotype DX Tests? 

The Oncotype DX breast recurrence score test shows the person’s risk of developing early stages of recurrent breast cancer and the test can help in learning if chemotherapy is beneficial to the person being tested.

The Oncotype DX DCIS score test shows the person’s risk of developing DCIS again or DCIS recurrence. DCIS is the beginning of breast cancer development. It can also help in learning how the person being tested can benefit from radiation therapy after DCIS therapy.

Oncotype DX genomic prostate score test can help show a man’s risk of developing prostate cancer. 

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover day care?

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