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Medicare Coverage for Prostate Specific Antigen (PSA) Test


Medicare will cover prostate-specific antigen tests for those who need it. Prostate cancer is prevalent among men. About one out of every nine men will receive a prostate cancer diagnosis. The blood test is considered a routine screening for beneficiaries. As long as your doctor takes Medicare, you should have coverage.

In conjunction with other testing methods, PSA tests can help screen for cancer at an early stage so you can get the best treatment available. Let’s go over what Medicare will cover when it comes to screening for prostate cancer.

Does Medicare Cover Prostate-Specific Antigen Tests?

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.

How Often Will Medicare Pay for a PSA Test?

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.

How Much do Prostate Specific Antigen Tests Cost?

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.

What’s the Difference Between a Prostate Specific Antigen Test and A Digital Rectal Exam?

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.

Does Medicare Cover Prostate Cancer Screenings

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.

Will Medicare Cover Prostate Specific Antigen Tests

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.

Will Medicare Advantage Cover Prostate Specific Antigen Tests

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.

How Do Medigap Plans Cover PSA Tests?

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.

FAQ’S

When will Medicare not cover a PSA test?
Medicare won’t pay outside of annual screening unless your doctor deems the PSA test medically necessary.
Does Medicare cover a prostate biopsy?
Part B benefits usually cover prostate biopsies for diagnostic purposes. Your doctor will need to state that a biopsy is necessary, and the doctor must accept Medicare. If you have an Advantage policy, you can also get coverage for prostate biopsies.
Does Medicare cover prostate surgery?
Medicare will cover prostate surgery if your doctor decides it’s necessary. Any inpatient surgery falls under Part A benefits. Outpatient surgical falls under Part B. Keep in mind you’ll pay a portion of the costs.

How to Get Medicare Coverage for Prostate Specific Antigen Testing

By testing for prostate cancer early on, you can better your chances of treating the disease. Remember that early detection is fundamental. Our team of Medicare experts can help answer your coverage questions about PSA tests. You never want to overpay for a plan that’s not a perfect fit for you. Let us help compare policies and prices for you. It’s as easy as calling the number above or filling out an online rate form.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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