Is the PSA Test Covered by Medicare?
Navigate Medicare coverage for PSA tests. Understand what's covered, associated costs, and practical steps for your screening.
A Prostate-Specific Antigen (PSA) test is a blood test used to measure the amount of prostate-specific antigen in a man’s blood. This protein is produced by both cancerous and noncancerous cells in the prostate, a small gland located below the bladder in males. The test serves as a screening tool to help detect prostate conditions, including prostate cancer, at an early stage. While elevated PSA levels can indicate prostate cancer, they can also signify other conditions, such as an enlarged or inflamed prostate.
Medicare Part B Coverage for PSA Tests
Medicare Part B provides coverage for annual PSA screening tests for eligible beneficiaries. All men aged 50 and older are covered for this preventive service. This screening is covered once every 12 months.
For the PSA test to be covered, it must be ordered by a doctor or another qualified healthcare provider. The healthcare provider must determine that the test is medically necessary for screening purposes.
Costs Associated with PSA Tests
For covered PSA tests, beneficiaries incur no out-of-pocket costs. This applies when the healthcare provider accepts Medicare assignment. While the PSA test is free as a preventive service, other related services, such as a digital rectal exam, may be subject to the Part B deductible and 20% coinsurance.
Medicare Advantage (Part C) plans are required to cover at least the same services as Original Medicare, including annual PSA tests. However, cost-sharing arrangements, such as copayments or deductibles, may vary depending on the individual Medicare Advantage plan. Beneficiaries enrolled in these plans should consult their plan documents for details on out-of-pocket expenses and network requirements. Medigap (Medicare Supplement Insurance) policies can help manage costs not covered by Original Medicare, such as the 20% coinsurance for other services and the Part B deductible. These supplemental plans can reduce a beneficiary’s financial responsibility for Medicare-approved services.
Obtaining a Covered PSA Test
To obtain a covered PSA test, an individual must have it ordered by a healthcare provider who accepts Medicare assignment. This includes doctors, physician assistants, or nurse practitioners.
The PSA test is performed by drawing a blood sample. This procedure can be done in various settings, including a doctor’s office, a laboratory, or an outpatient clinic. The ordering healthcare provider ensures the test is medically appropriate for screening, aligning with Medicare’s specific coverage guidelines for preventive services.