ORIGINAL MEDICARE
The prostate specific antigen (PSA) test, is a blood test that screens for prostate cancer. As most seniors are well over the recommended age to have their PSA checked, the once a year test, is generally covered by your Medicare benefits with no cost leftover for the beneficiary to pay.
This routine bloodwork tests for your PSA, which is a protein produced by cancerous and non-cancerous cells within a man’s prostate gland.
Once the sample is sent to the lab for analysis, the results come back in nanograms in relation to your PSA per ML of blood. Your physician will then determine the next course of action depending on those results.
If the blood levels are elevated, this could indicate a need for further cancer screening. In 1994 the Food and Drug Administration approved PSA and digital rectal exams (DRE) for further evaluation of prostate cancer.
Depending on symptoms, lab results and examination findings, your medical provider may have you undergo additional workups.
On occasion, elevated PSA could also be the result of a number of other medical conditions. Infections such as a UTI (urinary tract infection) or prostatitis, an enlarged or smaller than normal prostate, genetics and even something simple like advanced age can all lead to increased PSA results.
As long as your healthcare provider accepts Medicare, talk to them about eligibility and their recommendations regarding this routine exam
Medicare Coverage for Prostate Specific Antigen (PSA) Test
Medicare will cover your PSA test under your Part B benefits. As long as you’re currently a Medicare beneficiary, the day after turning 50 you become eligible for a PSA test.
After that, Medicare will cover your PSA labs once a year at no cost to the insured. Additionally, the Medicare beneficiary is not responsible for any Part B deductibles or coinsurance to be eligible for the PSA.
You’re DRE is also covered under your Medicare Part B benefits however, only at the 80% Medicare-approved amount. You’re still eligible after having turned 50 and can have the exam once a year, you’ll just be responsible for the remaining 20% not covered by the Traditional Medicare benefits.
Make sure your treating physician is a preferred Medicare provider otherwise, you may be subject to some healthcare fees outside of the Medicare guidelines.
Why a PSA is Important and Who Should Get Them
As cancer is a growing disease not just in the United States, but all across the world, routine cancer screenings are vitally important. Prostate cancer is one of the most common cancers in men and only secondary to skin cancer.
Coupled with the statistics that 1 in every 9 men will have a prostate cancer diagnosis in their lifetime, it’s easy to see why routine PSA’s are a no-brainer.
So who should have a yearly PSA you ask:
- Men in certain age brackets. For most men, at the age of 50 however, if you have high risk factors your medical care provider may start recommending a routine PSA for men as young as 40.
- For unknown reasons, certain races are more at risk. For example, men of African American decent are one of the races at risk where as Asian-American men are one of the least at risk. Depending on your race, ask your doctor if you’re considered more high risk.
- If you have a familial history of prostate cancer you’re more at risk. Especially in immediate family members such as a son, brother or father. Your chances increase even higher, and can even double, if you have several immediate family members affected with the disease.
- Geography can also put you at risk. Men residing in North America, Australia and Northwestern Europe are more at risk than men residing in Asia and Central or South America.
- Diet can also be a contributing factor as men who consume foods with high fat content are more at risk than men with a healthy diet.
If any of the above applies to you, don’t fret. Having a routine PSA means early detection. With prostate cancer, the cure rate is high! When treated in the early stages, most men are disease free after 5 years.
This is considerably good news, especially for Medicare beneficiaries, as you can have the test at no cost! Make sure to talk to your healthcare provider about routine PSA’s once you’re 50 or if you have any other, “at risk”, concerns.
Additional Information for PSA Testing
Even though your PSA is free through Medicare, you may have questions regarding other prostate cancer exams such as the DRE.
Additionally, there are other Medicare approved insurance policies that can help with preventative services and wellness programs which may not be offered with your Traditional Medicare benefits.
15 Additional Things that can Raise a Man’s PSA
According to an informative article on prostate, here are some additional items that may results in elevated PSA results:
- A mans PSA gradually rises as they grow older.
- A digital rectal exam (DRE) can aggravate the prostate and possibly raise PSA. Ideally, your physician should take your PSA prior to having the DRE. So make sure your healthcare provider always takes your PSA before undergoing a rectal exam.
- Having a prostate biopsy or surgery can elevate the PSA. Doctors typically will wait a while after having a biopsy so the PSA levels have time to return to normal.
- Having a catheter inserted due to a surgical procedure or other medical condition can cause the PSA levels to be increased.
- Having a UTI or urinary tract surgery. Both can cause an increase in the PSA as they both irritate the prostate.
- Certain cancer treatments like chemotherapy or certain medications taken for benign prostatic hyperplasia (BPH aka enlarged prostate) can cause an increase in PSA levels.
- Sexual intercourse, or having had a recent ejaculation can cause a temporary increase with the PSA levels. Doctor’s advise against any form of sex 24 hours prior to your PSA test.
- Bicycle riding or similar activities, like horse riding or using a tractor, can elevate the PSA temporarily.
- A pelvic injury secondary to sports or any other trauma to the prostate region can raise one’s PSA to rise.
- Body builders who use sport supplements typically have elevated PSA’s
These are just a few leading causes that can produce elevated PSA levels. There is a number of other reasons not listed, so the message is, don’t panic! If your PSA is slightly above normal think of the lifestyle aspects that may have caused this increase.
One of our licensed insurance agents can answer any questions regarding insurance coverage for PSA testing as well as tailor an insurance package based on your individual healthcare needs. There is never any obligation to buy, so call or click here to compare rates online today!