Medicare Coverage for Prostate Specific Antigen (PSA) Test

Medicare will cover a PSA test for men over the age of 50. You may even be able to get testing done if you’re under 50. But your doctor must feel it’s medically necessary. Keep in mind that having a vasectomy does not increase your risk for prostate cancer. A prostate-specific antigen test falls under your Part B benefits. Since the screening is preventive, you won’t pay coinsurance or deductibles.

Part B will cover prostate-specific antigen tests once every 12 months. Men over 50 can have a PSA test, beginning on their 50th birthday. You won’t be responsible for any charges for this testing since it’s preventive care.

A standard PSA test can cost you between $60 and $80. Depending on the care level you need following the initial screen, you can expect to pay more. You may need follow-up visits and screenings to further check for cancer. So, while your initial screen is free, it’s best to prepare for extra charges in the future.

While there are many different ways to check for prostate cancer, two remain the most popular. A prostate-specific antigen test is a blood test. The PSA level in the blood may be higher for those who are dealing with prostate-related issues.

A high level of PSA in the blood can mean a few things, such as:

• A reaction to certain medications.
• You may have an enlarged prostate.
• You may suffer from a prostate infection.

A digital rectal exam is a physical exam, rather than a simple blood test. Your doctor will check for abnormalities with your prostate, which may indicate cancer. You’ll want to ask your doctor beforehand to find out which test may be best for you.

Part B will cover both PSA tests to check for cancer, as well as digital rectal examinations. When you decide to move forward with a digital rectal exam, you’ll pay 20%. You’ll then pay the Part B deductible and any applicable copays. If you have a PSA test, you won’t be liable for costs. But you’ll need to be sure your doctor accepts Medicare, or you could have to pay the full costs.

Medicare Advantage policies must cover a minimum of what Medicare will cover. What exactly does this mean for you? While you’ll get a routine PSA test at no charge to you, there may be extra fees.

If your doctors decide he wants to run follow-up tests, you won’t need to pay for these. Instead, your Medicare Advantage policy will pay for screenings. Remember that Medicare advantage plans run within a network. Your provider and the facility you get treatment in will have to be in your network. If not, you’ll undoubtedly have high medical bills to pay.

Medicare Advantage policies must cover a minimum of what Medicare will cover. What exactly does this mean for you? While you’ll get a routine PSA test at no charge, there may be extra fees. If your doctor decides they want to run follow-up tests, you won’t need to pay. Instead, your Medicare Advantage policy will pay for screenings. Remember that Medicare advantage plans run within a network. Your provider and the facility where you get treatment will have to be in your network. If not, you’ll undoubtedly have high medical bills to pay.

Your Part A and B benefits only cover 80% of the costs of all prostate cancer-related treatments. By enrolling in a Medigap plan, you can save lots of money. A Medicare Supplement plan will cover the 20% of costs you’d have to cover. These plans are helpful in budgeting for your health care.