Does Medicare Cover the PSA Test?
This article was updated on: 09/10/2018
As a Medicare beneficiary, you may be eligible to receive one PSA test, also known as the prostate-specific antigen blood test, which screens for prostate cancer. You can get this test at no cost to you once each year, as long as your doctor accepts Medicare assignment and you meet certain eligibility requirements. Here’s what you should know about Medicare coverage for the PSA test.
What is the PSA test?
A PSA test is a simple blood test that measures substances in the blood that may indicate the presence of prostate cancer. In a man with a healthy prostate, these substances, prostate-specific antigens, are present in the blood in very tiny amounts, usually less than 4 ng/mL. In a person with prostate cancer or other prostate abnormalities, PSA levels become elevated above 4 ng/ML.
If your PSA test is elevated, but you have no other symptoms of prostate cancer, your doctor may recommend another screening test, such as a digital rectal examination, to rule out prostate cancer. If the rectal examination is negative, your doctor may recommend continued observation on a regular basis. Other conditions that may cause an elevated PSA level include an infection in the prostate (prostatitis) or an enlargement of the prostate (benign prostatic hyperplasia, or BPH).
However, if your rectal exam also shows suspicious findings, such as enlargement or a lump, your doctor may recommend other diagnostic tests such as a transrectal ultrasound of the prostate, or even a prostate biopsy, to confirm or exclude the presence of prostate cancer.
Who should get a PSA test?
Many health organizations recommend that prostate cancer screening tests such as the PSA test be included in routine physical screening for all men beginning at age 50 as part of their preventive health care. People who are at increased risk for prostate cancer may even have PSA screening even earlier, beginning at age 40 or 45. Your risk for prostate cancer may increase if any of the following applies to you:
- You are age 50 or older; the risk for developing prostate cancer increases with age.
- A family member has been diagnosed with prostate cancer.
- You are a member of certain ethnic groups, most commonly African Americans.
- Your diet is high in fatty foods.
In addition, if you’re displaying any symptoms of prostate cancer, your doctor may recommend a PSA test at any time. While many men with prostate cancer never experience any symptoms, those who do may have one or more of the following:
- Urinary frequency, weak urine stream, pain during urination, or blood in the urine or semen
- Difficulty maintaining an erection or ejaculating
- Pain in the hips, back, or pelvis that persists over time
When does Medicare cover the PSA test?
All men over 50 are eligible to receive a free PSA test once every 12 months under the preventive services benefits included in Medicare Part B. If your doctor accepts Medicare assignment, you pay nothing. If your doctor does not accept Medicare assignment, you may pay a fee for the doctor services, but not for the PSA test itself.
Where can I get more Information on PSA test?
If your health-care provider has recommended a PSA test and you have questions about Medicare and health screening tests, I would be happy to talk with you more about what Medicare covers. In addition, I can recommend other plan options, such as Medicare Advantage plans, which may cover additional preventive services beyond Part A and Part B, such as wellness programs.
To schedule a phone call or request an email with more information, click on one of the buttons below. You can also see what plans are available in your area by clicking the Compare Plans button. You can find out more about me by clicking the “View profile” link below.
For more information on the PSA screening, see:
National Cancer Institute, “Prostate-Specific Antigen (PSA) Test,” last updated July 24, 2012, http://www.cancer.gov/types/prostate/psa-fact-sheet