Your Medicare Coverage
Is my test, item, or service covered?
Prostate cancer screenings
How often is it covered?
- Digital rectal exam: Once every 12 months
- Prostate specific antigen (PSA) test: Once every 12 months
All men over 50 (beginning the day after your 50th birthday) with Part B are covered.
Your costs in Original Medicare
- Digital rectal exam: You pay 20% of the Medicare-approved amount for a yearly digital rectal exam and for the doctor's services related to the exam. The Part B deductible applies. In a hospital outpatient setting, you pay a copayment.
- PSA test: You pay nothing for a yearly PSA blood test. If you get the test from a doctor that doesn’t accept assignment, you may have to pay an additional fee for the doctor’s services, but not for the test itself.
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.