Does Medicare Cover Prostate Cancer Screenings?

Prostate cancer is the second most common cancer in American men.

According to the U.S. Centers for Disease Control and Prevention, 13 out of every 100 American men will get prostate cancer during their lifetime — and about two to three men will die from the disease.

Age is the most common risk factor. The older a man is, the more likely he is to develop prostate cancer.

There is no standard test to screen for prostate cancer, but the two most common are the prostate specific antigen, or PSA, test and a digital rectal examination.

A prostate specific antigen, or PSA, is a substance created by the prostate.

Generally, the higher the PSA level is in your blood, the more likely a prostate problem exists.

But PSA may also be elevated in other conditions that affect the prostate.

When used in conjunction with other prostate cancer tests — such as a digital rectal examination — PSA tests can aid in the decision-making process for diagnosing prostate cancer.

If your PSA test is abnormal, your doctor may recommend a biopsy to determine if you have prostate cancer.

A digital rectal examination allows a medical professional to check your prostate for nodules or other abnormalities.

The examination is performed when a health care provider inserts a gloved, lubricated finger into a man’s rectum to feel the prostate for any abnormalities, such as cancer.

In 2018, the U.S. Preventive Services Task Force stated that it does not recommend digital rectal examinations as a screening tool due to a lack of evidence on its benefits.

Medicare provides coverage for digital rectal exams and prostate specific antigen blood tests once every 12 months for all male beneficiaries ages 50 and older.

Both preventive services are covered under the Medicare Part B benefit.

The PSA blood test must be ordered by your doctor or a qualified nonphysician practitioner.

The digital rectal exam must be performed by a doctor or practitioner who is authorized by Medicare to complete the examination.

While Medicare covers PSA tests and digital rectal exams, you will likely pay different amounts for these services.

Medicare Advantage plans, which are administered by private insurance companies that contract with the federal government, offer the same prostate cancer screening coverage and costs as Original Medicare.