Medicare covers one annual prostate-specific antigen (PSA) test for people with prostates if they meet the eligibility guidelines and the test is medically necessary.
Medicare typically covers one annual PSA blood test through Medicare Part B (medical insurance) or Medicare Part C (Medicare Advantage). However, you must meet the eligibility criteria and receive your test from a healthcare professional who accepts Medicare or is in-network for your Advantage plan.
The PSA test is a blood test that measures the amount of PSA in the blood. In high levels, PSA may identify the presence of adenocarcinoma of the prostate before you experience any symptoms. But it can also help identify noncancerous conditions that increase PSA in the blood.
Keep reading to learn about the eligibility requirements for yearly PSA testing through Medicare, how much you can expect to pay, and what Medicare covers.
Medicare covers preventive services, including one yearly PSA blood test in people with prostates if they meet the following criteria:
- over age 50
- at least 11 months have passed since your previous PSA test
- the screening is ordered by your healthcare professional and deemed medically necessary
Medicare also covers a yearly preventive digital rectal exam.
A PSA blood test is free with Medicare if your healthcare professional “accepts assignment,” or the cost Medicare covers for this service.
You may have to pay an additional fee for the doctor’s services if they do not.
If you have Medicare Part C (Medicare Advantage), your plan should cover at least as much as Original Medicare (parts A and B) covers. However, you may need to make sure your healthcare professional is in-network for your specific plan to reduce your out-of-pocket costs.
A positive PSA test may indicate prostate cancer, but high levels of PSA in the blood can also happen due to other noncancerous reasons, such as:
- enlarged prostate, or benign prostatic hyperplasia (BPH)
- prostatitis, or inflamed prostate
- urinary tract infection (UTI)
- recent ejaculation
If your PSA test detects high levels of PSA in your blood, you may need additional tests to determine the diagnosis. This may include additional blood tests or imaging tests. If a doctor suspects prostate cancer, they may recommend a prostate biopsy to check for cancerous cells.
Medicare covers these tests as well as FDA-approved treatment for prostate cancer.
Why did Medicare deny my PSA test?
Medicare may deny your PSA test if your healthcare professional does not order it and deem it medically necessary. This may also happen if you get a PSA test before at least 11 months have passed from your previous test.
What is the average cost of a PSA blood test?
A PSA blood test is typically free with Medicare if you meet the criteria. Without insurance, a PSA test can range widely from under $100 to $300 and up, depending on whether you use an at-home test or visit a medical facility for testing.
How often should a 65-year-old have a PSA test?
The American Cancer Society recommends people with prostates get a yearly PSA test if their PSA levels are
How do I get a free PSA test?
Doctors may recommend a free PSA test if your PSA test results show high levels of PSA in the blood. A free PSA test measures the amount of PSA in your blood that’s not bound to any proteins.
A free PSA test is not considered a preventive service under Medicare. You may be responsible for paying your yearly premium plus 20% of the costs of each Medicare-covered service after meeting your deductible.
Medicare covers one yearly PSA test, along with one digital rectal exam, to support early detection of prostate cancer. These screenings help doctors diagnose prostate cancer before you experience symptoms, typically before the cancer has spread. Early detection can support improved treatment outcomes.
For the test to be fully covered, a doctor must deem it medically necessary, and you must meet the eligibility criteria. The medical professional must also accept the Medicare-approved cost for the test.
If you have a Medicare Advantage plan, you may need to visit a healthcare facility or professional in-network for the test to be covered.
