RE: Shore Cap Research Note 17 Jan17 Jan 2024 09:31
USA State efforts to ensure prostate cancer screening coverage
Many states have laws requiring private health insurers to cover tests to detect prostate cancer, including the PSA test and digital rectal exam (DRE). Some states also assure that public employee benefit health plans provide coverage for prostate cancer screening tests.
Most state laws assure annual coverage for men ages 50 and over and for high-risk men, ages 40 and over. “High-risk men” typically refers to African American men and/or men with a family history of prostate cancer. Some states have slightly different coverage requirements.
Laws on coverage vary from state to state, so check with your insurer or with your state insurance commissioner’s office to learn what’s covered.
Medicare coverage
Medicare covers a PSA blood test and a DRE once a year for all men with Medicare age 50 and over.
PSA test: You pay nothing for a yearly PSA blood test. If you get the test from a doctor who doesn’t accept assignment, you may have to pay a fee for the doctor’s services, but not for the test itself.
Digital rectal exam: If your doctor does this test, you pay 20% of the Medicare-approved amount for a yearly DRE and for your doctor’s services related to the exam. The Part B deductible applies. If the DRE is done in a hospital outpatient setting, there is a copayment.