Medicare's Coverage of PSA Screening

Medicare Part B covers a PSA (prostate-specific antigen) blood test once every 12 months for men age 50 and older, at no cost to you. The test measures a protein produced by the prostate gland and is used to screen for prostate cancer. You pay nothing for the test itself — no copay, coinsurance, or deductible — as long as your doctor orders it and the lab is in the Medicare network.

The coverage applies whether you have symptoms or not. Your doctor can order the test during a routine visit, and Medicare will pay for it. However, coverage is limited to the blood test alone. If your doctor wants to perform a digital rectal exam (DRE) at the same visit to check the prostate by hand, that exam is also covered once per year at no cost.

You do not need to be enrolled in a Medicare Advantage plan to receive this coverage — Original Medicare (Part A and Part B) covers PSA screening automatically. If you have a Medicare Advantage plan, your coverage should be at least as good as Original Medicare, though you should check your plan documents to confirm any specific requirements.

Key Takeaways

  • Medicare Part B covers one PSA blood test per year for men age 50 and older at no cost to you.
  • A digital rectal exam performed at the same visit is also covered once per year with no out-of-pocket charge.
  • Your doctor must order the test, and the lab must be in the Medicare network for you to pay nothing.
  • If your PSA result is abnormal, follow-up tests such as ultrasounds or biopsies are not automatically covered under the screening benefit and may require you to pay a portion of the cost.

What Happens If Your PSA Test Shows an Abnormal Result

If your PSA level is higher than normal, your doctor may recommend additional testing to determine whether cancer is present. These follow-up tests — such as a transrectal ultrasound, MRI, or prostate biopsy — are not part of the free screening benefit. Instead, they are covered under Medicare Part B as diagnostic services, which means you typically pay 20 percent of the cost after you meet your annual deductible.

The exact amount you pay depends on where the test is performed and whether the facility is hospital-based or independent. A biopsy performed in a hospital outpatient department may cost you differently than one done in a doctor's office. Before scheduling any follow-up test, ask your doctor's office what the Medicare-approved amount is and what your share will be.

If you have a Medigap supplemental insurance policy, it may cover some or all of the 20 percent coinsurance for these diagnostic tests. If you have a Medicare Advantage plan, your out-of-pocket costs depend on your specific plan's rules and network.

Who Should Get PSA Screening and When

Medicare covers PSA screening for all men age 50 and older, but whether you should have the test is a decision to make with your doctor. The American Cancer Society and other medical organizations recommend that men discuss the benefits and risks of PSA screening with their doctor before age 50 if they are at higher risk — for example, if they are Black or have a family history of prostate cancer.

Some men choose not to be screened because PSA tests can produce false positives, meaning the test suggests cancer may be present when it is not. A false positive can lead to anxiety and additional testing. Other men want the screening because early detection of prostate cancer can sometimes allow for treatment before the cancer spreads. Your doctor can help you weigh these factors based on your age, health, and family history.

Once you and your doctor decide to proceed with screening, Medicare will cover the test once per calendar year. If you have not had a PSA test in the past 12 months, you can schedule one at your next doctor's visit.

How to Schedule Your PSA Screening

To get your PSA screening covered by Medicare, start by calling your primary care doctor's office and asking for an appointment. Tell them you want a PSA screening. Your doctor will order the blood test, and the office will direct you to a lab that accepts Medicare.

Most labs that work with Medicare are in-network, meaning they have agreed to accept Medicare's payment as full payment for the test. You should not receive a bill. If a lab tries to bill you for the PSA test itself, contact Medicare at 1-800-MEDICARE to report it.

Bring your Medicare card to the lab appointment. The lab will verify your coverage before drawing blood. The results typically come back within a few days and are sent to your doctor's office. Your doctor will contact you to discuss the results and next steps.

Medicare Advantage Plans and PSA Screening

If you are enrolled in a Medicare Advantage plan (Part C), your plan must cover PSA screening at least as well as Original Medicare does. This means your plan must cover one PSA test per year at no cost. However, some Medicare Advantage plans may have additional requirements, such as using a specific lab or getting a referral from your primary care doctor.

Check your plan's summary of benefits or call the plan's customer service number to confirm the exact coverage rules before scheduling your test. Some plans may waive the copay for the screening but charge you for the office visit itself, so it is worth asking about the total cost.

If you switch from Original Medicare to a Medicare Advantage plan or vice versa, your screening coverage continues. There is no gap in coverage for PSA screening when you change plans.

What Is Not Covered Under PSA Screening

Medicare's free PSA screening benefit covers only the blood test and the digital rectal exam once per year. Any additional testing triggered by an abnormal result — such as imaging or biopsy — is covered as a diagnostic service, not as screening, and you will pay coinsurance.

Genetic testing to assess your risk of prostate cancer is not covered as part of routine screening. If your doctor believes genetic testing is medically necessary based on your personal or family history, it may be covered as a diagnostic test, but you should ask your doctor whether Medicare will cover it before proceeding.

Screening performed more than once per calendar year is not covered. If you have already had a PSA test in the past 12 months, Medicare will not pay for another one until 12 months have passed from the date of your last test.

Questions to Ask Your Doctor Before PSA Screening

Before you schedule a PSA test, consider asking your doctor these questions to make an informed decision:

  • Based on my age and health history, do you recommend PSA screening for me?
  • What are the benefits and risks of PSA screening in my situation?
  • What does a normal PSA result mean, and what would an abnormal result mean for me?
  • If my PSA is abnormal, what follow-up tests might you recommend, and what would those cost me?
  • How often should I be screened if I decide to proceed?

Frequently Asked Questions

Do I have to be age 50 to get PSA screening covered by Medicare?

Yes, Medicare covers PSA screening only for men age 50 and older. If you are under 50, Medicare will not cover the test. However, if you are at very high risk — for example, because of a strong family history of prostate cancer — your doctor may recommend screening, and you would pay out of pocket.

What if I had a PSA test less than 12 months ago?

Medicare covers one PSA test per calendar year. If you had a test within the past 12 months, Medicare will not cover another one until 12 months have passed from your last test. Your doctor can note the date of your previous test to avoid scheduling too soon.

Will Medicare cover a PSA test if I have no symptoms?

Yes. Medicare covers PSA screening for all men age 50 and older as a preventive service, regardless of whether you have symptoms. You do not need to have any signs of prostate problems to receive the screening benefit.

What should I do if a lab bills me for my PSA test?

Contact Medicare at 1-800-MEDICARE to report it. The PSA screening test should be free to you under Medicare Part B. If a lab is billing you, they may not be in the Medicare network, or there may be a billing error that Medicare can help resolve.

Does my Medicare Advantage plan cover PSA screening the same way as Original Medicare?

Your Medicare Advantage plan must cover PSA screening at least as well as Original Medicare, meaning one free test per year. However, your plan may have additional rules, such as requiring a referral or using a specific lab. Call your plan to confirm the exact coverage before scheduling.