What Medicare Covers for PSA Testing and Prostate Cancer Screening

Medicare Coverage for PSA Tests

Medicare Part B covers a PSA (prostate-specific antigen) test once every 12 months for men age 50 and older, at no cost to you. The test itself is free — you pay nothing at the time of service. Your doctor orders the test through a lab or clinic, and Medicare pays the provider directly. The test measures a protein in the blood that may signal prostate cancer or other prostate conditions.

Coverage applies only if your doctor orders the test as part of your routine care. If you have symptoms like difficulty urinating or blood in urine, or if you have a personal or family history of prostate cancer, your doctor may order the test more frequently, and Medicare will still cover it. The key is that a doctor must order it — you cannot order a PSA test on your own and expect Medicare to pay.

If you have Original Medicare (Part A and Part B), you are covered. If you are in a Medicare Advantage plan (Part C), coverage rules may differ slightly depending on your specific plan, though most plans cover the annual PSA test the same way Original Medicare does. Check your plan documents or call your plan to confirm.

Key Takeaways

Medicare Part B covers one PSA test per year for men age 50 and older at no cost to you.
Your doctor must order the test — you cannot request it directly from a lab and have Medicare pay.
If you have symptoms or risk factors, your doctor may order more frequent tests, and Medicare will cover those too.
Medicare Advantage plans usually cover the annual PSA test, but you should verify with your specific plan before the test.
You pay nothing for the test itself if it is ordered by your doctor and performed at a Medicare-enrolled provider.

Who Is Covered and Age Requirements

Medicare covers PSA testing for men age 50 and older. If you are under 50, Medicare does not cover routine PSA screening, even if you have a family history of prostate cancer. Some men with a strong family history or other risk factors may discuss earlier screening with their doctor, but Medicare will not pay for it.

If you are age 50 or older and have Medicare Part B, you are covered for one PSA test per calendar year. There is no income limit, no medical underwriting, and no waiting period. As long as your doctor orders it and you have been enrolled in Part B for at least one day, you are covered.

Men age 40 and older with a family history of prostate cancer, or men of African descent (who have higher prostate cancer risk), may want to discuss screening with their doctor even before age 50. Your doctor can explain the benefits and risks of early screening, but understand that Medicare will not cover it until you turn 50.

What the Test Costs and What You Pay

The PSA test itself costs you nothing when ordered by your doctor and performed at a Medicare-enrolled provider. Medicare Part B covers 100 percent of the test cost. You do not pay a copay, coinsurance, or deductible for the PSA test itself.

However, if the test is part of a broader office visit or physical exam, you may owe a copay for the visit itself. That copay is separate from the PSA test coverage. For example, if you see your doctor for an annual wellness visit and the doctor orders a PSA test during that visit, you may owe a copay for the wellness visit, but the PSA test portion is covered at no additional cost.

If you go to an out-of-network lab or provider, costs may be higher and Medicare may not cover the full amount. Always confirm that the lab or clinic where your doctor sends you accepts Medicare assignment, meaning they agree to accept Medicare's payment as full payment.

How to Get a PSA Test Through Medicare

The first step is to schedule an appointment with your primary care doctor or a urologist. Tell them you want to discuss PSA screening. Your doctor will review your age, health history, and risk factors, and decide whether to order the test. If your doctor agrees, they will send the order to a lab or clinic.

When you arrive for the test, bring your Medicare card. The lab or clinic will verify your coverage and process the test. The test itself takes a few minutes — it is a straightforward blood draw. Results usually come back within a few days to a week, and your doctor will contact you with the results.

If you do not have a primary care doctor, you can see any doctor who accepts Medicare. Call your local hospital or search Medicare's provider directory at Medicare.gov to find doctors in your area. If cost is a concern, some community health centers offer low-cost or free PSA testing, though you should still have Medicare process the claim if you are covered.

Medicare Advantage Plans and PSA Coverage

If you are enrolled in a Medicare Advantage plan (Part C), your plan must cover at least the same services that Original Medicare covers, including the annual PSA test. However, your plan may have different rules about where you can get the test, whether you need a referral, or what you pay out of pocket.

Some Medicare Advantage plans charge a copay for the PSA test even though Original Medicare does not. Others may require you to use an in-network provider. Before your test, call your plan's customer service number (on the back of your card) and ask: "Does my plan cover a PSA test, and what do I pay?" This takes five minutes and prevents surprises.

If your Medicare Advantage plan does not cover the test or charges more than you want to pay, you have the right to switch back to Original Medicare during the annual open enrollment period (October 15 to December 7 each year). However, you cannot switch plans just for one test — the change takes effect January 1 of the following year.

Screening Recommendations and When to Talk to Your Doctor

Medical organizations have different views on routine PSA screening. The American Cancer Society recommends that men age 50 and older discuss the benefits and risks of PSA screening with their doctor before deciding whether to be tested. Men at higher risk — those with a family history of prostate cancer or men of African descent — may want to start this conversation at age 40 or 45.

The PSA test is not perfect. A high PSA level can mean prostate cancer, but it can also mean benign prostate enlargement, infection, or other non-cancerous conditions. Some men have high PSA levels but never develop cancer. This is why your doctor should discuss the test with you first — to make sure you understand what the results might mean and what happens next if your PSA is elevated.

If your PSA test comes back normal, Medicare covers another test one year later. If your PSA is elevated, your doctor may recommend a repeat test, an ultrasound, or a biopsy. Medicare covers these follow-up tests as medically necessary, even if they happen more than once per year.

Frequently Asked Questions

Do I have to be 50 to get a PSA test covered by Medicare?

Yes, Medicare covers PSA testing only for men age 50 and older. If you are younger than 50, Medicare will not pay for routine PSA screening, even if you have a family history of prostate cancer. Your doctor can still order the test, but you would pay out of pocket.

What if my PSA test comes back high?

If your PSA is elevated, your doctor will discuss next steps with you. This might include a repeat test, a digital rectal exam, an ultrasound, or a biopsy. Medicare covers these follow-up tests as medically necessary. Your doctor will explain what the results mean and what your options are.

Can I get a PSA test more than once a year?

Medicare covers one PSA test per 12 months as routine screening. If you have symptoms, a history of prostate cancer, or your doctor has medical reasons to test more often, Medicare will cover additional tests. The key is that your doctor must order them and document the medical reason.

Do I need a referral to get a PSA test?

No referral is required. You can schedule an appointment with your primary care doctor or any doctor who accepts Medicare, and ask for a PSA test. If your doctor agrees it is appropriate, they will order it. Some Medicare Advantage plans may require a referral, so check with your plan first.

What if I use an out-of-network lab?

If you use a lab that does not accept Medicare assignment, you may owe more money out of pocket. Always confirm that the lab or clinic where your doctor sends you accepts Medicare before the test. If you are unsure, call the lab and ask, or ask your doctor to send you to a Medicare-enrolled provider.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.