Does Medicare Cover Digital Rectal Exams?
Last Updated : 05/28/20193 min read
If you have health-care coverage through the Original Medicare (Part A and Part B) program, and your doctor or other provider has recommended you have a digital rectal exam, or DRE, your test may be covered under Part B, subject to your deductible and coinsurance amounts.
What is a digital rectal exam?
During a digital rectal exam, your doctor will insert a gloved and lubricated finger into your rectum to feel the size, shape, and texture of your prostate gland.
This is usually done as part of a screening process for prostate cancer, although your doctor may perform a rectal exam for other reasons, such as to check for hemorrhoids or to help identify the cause of rectal bleeding.
Should I get a digital rectal exam?
Prostate cancer is the second leading cause of cancer death among men, and in fact, according to the National Cancer Institute, more than half of American men have cancer cells in their prostate glands by the time they reach age 80. In many cases, these cancer cells can start growing anywhere from 10 to 30 years earlier, but may not become large enough to show symptoms for decades. In the United States, men have a 14% chance of experiencing prostate cancer over the course of their lifetime.
You are at increased risk of developing prostate cancer if:
- You are over 50; your risk increases with age.
- You have a family history of prostate cancer.
- You belong to certain ethnic groups that are at higher risk, including African Americans.
- You eat a diet high in fat.
If you have any of the risk factors for prostate cancer, or are experiencing any of the following symptoms that are associated with the disease, your doctor may recommend prostate cancer screening with a digital rectal exam, and/or a PSA (prostate-specific antigen) blood test.
Prostate cancer symptoms:
- Painful urination, weak urine stream, difficulty starting or stopping urination
- Frequent urination, especially during at night
- Pain or difficulty during sexual intercourse
- Persistent back, hip, or pelvic pain
- Blood in urine or semen
Does Medicare cover digital rectal exams?
If you are over age 50 and have Part B, Medicare covers a digital rectal exam once every 12 months. The following conditions apply:
- Eligibility begins the day after your 50th birthday.
- You pay 20% of the Medicare-approved amount, after your Part B deductible, for a digital rectal exam performed in a doctor’s office.
- If you get the test in an outpatient hospital setting, you pay a copayment for the test.
You may also be eligible to receive a PSA blood test to screen for prostate cancer at no cost to you once every 12 months if you’re over 50, as long as your doctor accepts Medicare assignment.
Where can I get more information on digital rectal exams?
If you have questions about Medicare preventive services, including the digital rectal exam, I would be happy to provide you with the information you need. I can also let you know about other Medicare plan options, such as Medicare Advantage plans, that may cover additional benefits, such as wellness programs or routine vision and dental.
You can schedule a phone call or request an email by clicking one of the links below. For more information about plans in your area you may be eligible for, click on the Compare Plans button. You can click the “View profile” link to find out more about me.