Insurance Coverage for Prostate Cancer Screening

The American Cancer Society supports legislation assuring that men have insurance coverage for prostate screening exams. The Society recognizes that differing opinions exist as to whether screening for prostate cancer lowers the risk of dying from prostate cancer. Until such time when studies are conclusive, men, 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 recommend routine testing for prostate cancer for all men at this time because we believe proper pretest guidance and education is necessary. Doctors and other health care providers should offer information on the potential risks and benefits of prostate-specific antigen (PSA) testing to appropriate patients, allowing them to make an informed decision on testing.

State efforts to ensure prostate cancer screening coverage

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 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 see what’s covered.

Medicare coverage

Medicare covers PSA blood test and a DRE 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 (including a DRE), the beneficiary would pay 20% of the Medicare-approved amount after the yearly Part B deductible.