Medicare's PSA Test Coverage After 70

Medicare Part B covers one PSA (prostate-specific antigen) test per year for men age 50 and older, including men over 70. There is no age limit that stops this coverage — if you turn 70, 80, or 90, you remain covered for an annual PSA test as long as you have Part B. You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible; Medicare pays the other 80 percent.

The test itself is straightforward: a blood draw at a lab or doctor's office. Your doctor orders it, usually during a routine visit. Medicare covers the lab work, not a separate office visit fee. If your doctor thinks you need more than one PSA test in a year — for example, if your previous result was abnormal — Medicare may cover additional tests, but your doctor has to document the medical reason.

Key Takeaways

  • Medicare Part B covers one PSA test per year for all men age 50 and older, with no upper age limit.
  • You pay 20 percent of the Medicare-approved cost after your Part B deductible; Medicare covers 80 percent.
  • Your doctor must order the test; you cannot order a PSA test on your own and expect Medicare to pay.
  • If your doctor documents a medical reason for more than one test per year, Medicare may cover the additional tests.
  • Private Medigap or Medicare Advantage plans may cover your 20 percent coinsurance, depending on your plan.

How the Cost Works

Your out-of-pocket cost depends on whether you have already met your Part B deductible for the year. The Part B deductible changes each year — in 2024 it was $240, but it varies annually. Once you pay that deductible, you owe 20 percent of the Medicare-approved amount for the PSA test itself.

The Medicare-approved amount is set by Medicare, not by the lab or doctor's office. If a lab charges more than the approved amount, they cannot bill you for the difference — that is called "balance billing," and it is not allowed for Medicare-covered services. Ask your lab or doctor's office what the Medicare-approved amount is before the test if you want to know your exact cost.

If you have a Medigap (supplemental insurance) plan or a Medicare Advantage plan, your coinsurance may be covered partly or fully. Check your plan documents or call your plan to see what you owe for lab work.

When Your Doctor Might Order More Than One Test Per Year

Medicare covers additional PSA tests beyond the annual one if your doctor has a medical reason. Common reasons include a previous abnormal result, a family history of prostate cancer, or symptoms that warrant follow-up. Your doctor documents the reason in your medical record, and Medicare reviews it.

If you have had prostate cancer or are being monitored for it, your oncologist or urologist may order PSA tests more frequently — sometimes every few months. Medicare typically covers these because they are medically necessary, not routine screening. Again, your doctor's documentation of the reason is what Medicare uses to decide.

Do not assume Medicare will pay for extra tests without your doctor's order. If you pay out of pocket for a PSA test your doctor did not order, Medicare will not reimburse you.

The Difference Between Screening and Diagnostic Testing

A screening PSA test is one you get when you have no symptoms — it is looking for early signs of prostate cancer. Medicare covers one screening PSA per year for men 50 and older. This is the test most men over 70 receive during a routine physical.

A diagnostic PSA test is one your doctor orders because you have symptoms (such as difficulty urinating) or an abnormal previous result. Medicare covers diagnostic PSA tests separately from the annual screening limit. Your doctor decides whether the test is screening or diagnostic based on your medical situation.

This distinction matters because it affects how many tests Medicare will pay for in a year. If you have had your one annual screening test and your doctor then orders a diagnostic test because of a symptom, Medicare covers both.

What Happens After Your PSA Test

Your doctor receives the result and discusses it with you. A normal PSA result typically means no further testing is needed that year. If your result is elevated or abnormal, your doctor may recommend a repeat test, a digital rectal exam, or a referral to a urologist for further evaluation.

If a biopsy or imaging test (such as an ultrasound or MRI) is recommended, those are separate services with their own Medicare coverage rules. A biopsy is usually covered if medically necessary; imaging may be covered depending on the type and the reason. Your doctor's office can tell you what Medicare covers for the next step.

Medicare Advantage Plans and PSA Coverage

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your plan must cover at least the same PSA screening that Original Medicare does — one test per year for men 50 and older. However, your plan may have different rules about where you can get the test, which labs are in-network, or what you pay out of pocket.

Some Medicare Advantage plans cover additional preventive services beyond what Original Medicare covers, or they may have lower copays for lab work. Check your plan's summary of coverage or call your plan to confirm what you owe for a PSA test.

Frequently Asked Questions

Does Medicare stop covering PSA tests at a certain age?

No. Medicare covers one PSA test per year for all men age 50 and older, regardless of age. There is no cutoff at 70, 75, or any other age. As long as you have Part B, you remain covered.

Do I need a referral to get a PSA test?

No referral is required. Your primary care doctor can order a PSA test directly, or you can ask your doctor to order one during a routine visit. You do not need permission from Medicare or a specialist.

What if my doctor recommends I not get a PSA test after 70?

That is a conversation between you and your doctor. Some doctors recommend against routine PSA screening in older men because of the risk of false positives and unnecessary treatment. Medicare covers the test, but whether you should have it is a medical decision you make with your doctor based on your health and preferences.

Will Medicare pay if I get a PSA test at a walk-in lab without my doctor's order?

No. Medicare only covers a PSA test when your doctor orders it. If you pay for a test on your own without a doctor's order, Medicare will not reimburse you, even if you are over 70 and have Part B.

What if my PSA result is abnormal — does Medicare cover the follow-up?

Medicare covers follow-up testing if your doctor orders it for a medical reason. This may include a repeat PSA test, a biopsy, or imaging. Your doctor determines what is medically necessary, and Medicare reviews the documentation. You will owe your usual coinsurance for each service.