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Does Medicare Cover Prostate Cancer Screenings?

Medicare Bob
Medicare General Info
Find out all the details about prostate cancer screenings for men’s health and whether your Medicare plan can cover them.
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Prostate cancer is second only to skin cancer as the most commonly occurring type of cancer in men. While men under 40 are rarely diagnosed with prostate cancer, the American Cancer Society (ACS) estimates about 60% of men older than 65 will have prostate cancer at some point in their life.

Prostate cancer — a disease that begins when a single cell in the prostate gland mutates and starts multiplying rapidly — is far from a death sentence, though. Five-year relative survival rates are nearly 100%, but early detection is vital to help treat prostate cancer before it spreads to other parts of the body.

Screenings play an important role in early detection, but can Medicare cover the cost? The short answer: Yes, Medicare can help cover some of the fees associated with screenings for prostate cancer. Let’s take a closer look at what’s involved in prostate cancer screenings and which aspects Medicare may help cover.

When To Get Screened for Prostate Cancer

Screening is important because, in its early stages, prostate cancer is often asymptomatic. ACS recommends that all men at average risk of prostate cancer begin discussing screenings with their doctors by age 50.

Some people are at higher risk for prostate cancer than others. According to the Centers for Disease Control and Prevention (CDC), you could be at higher risk for prostate cancer based on your:

  • Age … Risk increases the older you get.

  • Race … African American men are at higher risk than others.

  • Family history … Having first-degree relatives diagnosed with prostate cancer before age 65 increases your risk.

If you are in a high-risk group, ACS recommends that you begin discussions about screening with your doctor at 45. If you have more than one first-degree relative who developed prostate cancer before 65, ACS recommends you start discussing screenings with your doctor at age 40.

During these conversations, your health care provider will assess your risk of prostate cancer and suggest a plan for when to begin screenings, which tests to get and how often to get screened.

Medicare Coverage for Prostate Cancer Screenings

The prostate-specific antigen (PSA) test is the most common tool used for prostate cancer screenings. It’s a simple blood test that measures the level of antigens your prostate cells produce. An elevated level could be an indication of prostate cancer or another health condition, such as an enlarged or inflamed prostate.

A digital rectal exam (DRE) is another screening tool during which the doctor will insert a finger into a patient’s rectum to feel for bumps or other abnormal areas on the prostate that could indicate the growth and development of cancer.

Medicare Part B can cover one PSA and DRE test every 12 months beginning the day after a man’s 50th birthday. If you’re under 50 but considered high risk for prostate cancer, Medicare Part B may cover some of the screening costs because it is considered medically necessary.

Additional Prostate Cancer Screening Tools

More detailed tests, such as MRI, ultrasounds and biopsies, could be ordered if the PSA or DRE tests show abnormal results. In some cases, a prostate cancer gene 3 (PCA3) RNA urine test may be performed.

If a healthcare provider orders these additional screening methods, they may fall under Medicare Part B as outpatient procedures. Medicare Part B can pay 80% of the approved amount, with the patient paying the remaining 20% after meeting the Part B deductible.

To learn more about prostate cancer screening coverage options, call Senior Healthcare Direct at 1-833-463-3262, TTY 711 to speak with a licensed agent.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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