Prostate Cancer Early Detection

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Insurance coverage for prostate cancer screening

State efforts to ensure prostate cancer screening coverage

The American Cancer Society supports legislation assuring that men will receive insurance coverage for prostate screening exams. The Society recognizes that differing opinions exist as to whether early detection testing for prostate cancer lowers disease-specific mortality. Until such time when studies are conclusive, patients, in consultation with their doctors, should be free to determine on an individual basis whether testing is appropriate. Prostate cancer screening should not be prevented because of the reimbursement limitations of health insurance plans.

The American Cancer Society does not support routine testing for prostate cancer at this time because we believe proper pretest guidance and education is necessary. Doctors and other clinicians should provide information on the potential risks and benefits of PSA testing to appropriate patients, allowing them to make an informed decision on testing.

States have passed laws on a variety of issues relating to prostate cancer including:

  • Assured health insurance coverage for prostate cancer screening
  • Public education on prostate cancer
  • Prostate cancer research funds

Many states have laws assuring that private health insurers cover procedures to detect prostate cancer, including the PSA test and DRE (see table below). Some of these states also assure that public employee benefit health plans provide coverage for prostate cancer screening procedures. Most state laws assure annual coverage for men ages 50 and over and for high-risk men, ages 40 and over. High risk refers to African-American men and/or men with a family history of prostate cancer. Some states may have slightly different coverage requirements.

States with prostate cancer screening coverage laws

    State

    States with prostate cancer screening coverage laws

    States with prostate cancer screening mandated offering laws*

 

    Alaska

    X

 

    Arkansas

    X

 

    California

    X

 

    Colorado

    X

 

    Connecticut

    X

 

    Delaware

    X

 

    Georgia

    X

 

    Illinois

    X

 

    Indiana

    X

 

    Kansas

    X

 

    Louisiana

    X

 

    Maine

    X

 

    Maryland

    X

 

    Minnesota

    X

 

    Missouri

    X

 

    New Jersey

    X

 

    New York

    X

 

    North Carolina

    X

 

    North Dakota

    X

 

    Oklahoma

 

    X

    Rhode Island

    X

 

    South Carolina

    X

 

    South Dakota

    X

 

    Tennessee

    X

 

    Texas

    X

 

    Vermont

    X

 

    Virginia

    X

 

    Washington

    X

 

    Wyoming

    X

 
* A Mandated Offering Law requires insurance companies to offer coverage for prostate cancer screening. It is not required that the purchaser select prostate cancer screening coverage.
Sources: National Conference of State Legislatures, October 2011 accessed at http://www.ncsl.org/issues-research/health/prostate-cancer-screening-mandates.aspx on August 16, 2013; Department of Insurance, State of South Carolina

Medicare coverage

Medicare covers a DRE and a prostate-specific antigen (PSA) blood test once a year for all men with Medicare age 50 and over. There is no co-insurance and no Part B deductible for the PSA test. For other services, the beneficiary would pay 20% of the Medicare-approved amount after the yearly Part B deductible.


Last Medical Review: 08/28/2013
Last Revised: 02/25/2014