Does Medicare Cover PSA Tests? (2026)

Quick Answer: What Medicare Pays for PSA Tests in 2026

Yes. Medicare Part B covers one PSA blood test per year at $0, no deductible, no copay, for all male Medicare beneficiaries age 50 and older. A digital rectal exam (DRE) is included in the same annual prostate cancer screening benefit, also at $0. The only time cost-sharing applies is when the PSA is ordered for diagnostic reasons because symptoms are present, not for routine annual screening.

What Original Medicare Covers: Preventive vs. Diagnostic PSA

Original Medicare draws a clear line between screening and diagnosis. The annual preventive PSA test is authorized under Section 1861(oo) of the Social Security Act, which defines the prostate cancer screening benefit. For a man age 50 or older with no current symptoms of prostate problems, Medicare pays 100% of the approved amount, meaning your out-of-pocket cost is $0. The 12-month rule is calendar-based: you can get one PSA covered per Medicare benefit period running 12 months from the last one.

When a PSA test is ordered because a man already has symptoms such as urinary frequency, difficulty urinating, pelvic pain, or blood in urine, Medicare classifies it as a diagnostic test rather than a preventive one. Diagnostic PSA orders are billed under standard outpatient Part B rules. For 2026, that means the 2026 Part B deductible of $283 applies first, then Medicare pays 80% of the approved amount and you owe 20% coinsurance. If you have Medigap, the supplement covers that 20%.

Medicare Advantage and the PSA Test Benefit (2026)

Medicare Advantage (Part C) plans are required by law to cover every preventive service that Original Medicare covers, including the annual PSA test, at $0 cost to the member. This requirement applies to all Medicare Advantage plans nationwide regardless of the plan's network design (HMO, PPO, PFFS, or SNP). However, Medicare Advantage plans may require the PSA test to be ordered by an in-network provider or performed at an in-network laboratory. Getting the test from an out-of-network provider on an HMO plan could result in a denial, so confirm your lab and ordering physician are in-network before the test.

Some Medicare Advantage plans offer additional cancer screening benefits beyond the Original Medicare floor, such as coverage of follow-up confirmatory tests or expanded coordination with urology specialists. Check your plan's Evidence of Coverage (EOC) document for the exact wording on prostate cancer screening, or call the plan member services number.

Age Rules and Eligibility: Who Qualifies for the Free PSA Test

Medicare's prostate cancer screening benefit covers male beneficiaries age 50 and older. There is no requirement to have prior symptoms or a family history of prostate cancer to receive the free annual screening. Any man enrolled in Medicare Part B who is 50 or older can request the test once every 12 months at $0. Medicare's coverage standard is deliberately broader than clinical guidelines from the USPSTF (which focuses its Grade C shared decision-making recommendation on men ages 55 to 69). Medicare covers earlier, at age 50, because Congress set the benefit threshold in statute.

Men who are dual-eligible (enrolled in both Medicare and Medicaid) pay $0 for the annual PSA screening regardless. Medicaid cost-sharing assistance programs pick up any remaining cost-sharing for dual-eligibles, but because the preventive PSA is already $0 under Medicare, there is nothing left to pay. Dual-eligible men should confirm their Medicare Part B is active, since Part B is what funds the prostate cancer screening benefit.

USPSTF Guidance and the Shared Decision-Making Conversation

The U.S. Preventive Services Task Force (USPSTF) issued a Grade C recommendation on PSA-based prostate cancer screening for men ages 55 to 69, meaning the task force recommends that men in this age group discuss the potential benefits and harms with their doctor and make a personalized decision. The USPSTF does not recommend routine PSA screening for men 70 and older because the potential harms (false positives leading to unnecessary biopsies and treatment side effects) generally outweigh the benefits for older men. For men under 55, the USPSTF does not have a specific recommendation.

Medicare's coverage is broader than the USPSTF recommendation. Medicare covers the annual PSA from age 50 onward with no age cap, regardless of what a clinical guideline says. This means a 71-year-old Medicare beneficiary can still request a free annual PSA test under Medicare Part B, even though the USPSTF advises against routine screening at that age. The coverage is available; the decision whether to use it belongs to the patient and their doctor after a shared decision-making conversation.

How to Get the Free Annual PSA Test Under Medicare

Getting the annual PSA test covered at $0 under Medicare Part B is straightforward. Ask your primary care provider or urologist to order the test specifically as the annual prostate cancer screening and confirm it will be billed as a preventive service. The distinction in how the test is coded (preventive versus diagnostic) determines your cost.

• Step 1: Schedule an annual wellness visit or a standalone appointment with your primary care provider or urologist.
• Step 2: Request the prostate cancer screening benefit specifically. Tell your provider you want the annual PSA covered under Medicare's preventive benefit.
• Step 3: Confirm the ordering provider and the laboratory are both in-network (critical for Medicare Advantage HMO plans).
• Step 4: Verify the test is not being ordered because of symptoms. If you have symptoms, the test is diagnostic and standard Part B cost-sharing applies.
• Step 5: After the test, review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) to confirm the claim was processed as a preventive service at $0.

Cost Without Medicare Coverage and What Medigap Covers

For men who are not yet enrolled in Medicare or who receive a diagnostic PSA (not preventive), the out-of-pocket cost of a PSA blood test varies. Without any insurance, a PSA test at a commercial laboratory typically runs $30 to $100 depending on region and lab, according to FAIR Health consumer data. If the test is ordered alongside a complete urological panel, total costs can reach $200 to $400 out-of-pocket.

For Medicare beneficiaries who receive a diagnostic PSA due to symptoms, the 2026 Part B deductible of $283 applies if not yet met for the year, plus 20% coinsurance on the Medicare-approved amount for the lab draw. Medigap plans (Plans C, D, G, N, and others) cover that 20% coinsurance and most cover the Part B deductible as well, depending on the plan letter. If you have Medigap Plan G, your out-of-pocket for a diagnostic PSA after meeting the 2026 deductible is $0.

Does Original Medicare cover PSA tests for free?

Yes. Original Medicare Part B covers one PSA blood test every 12 months at $0 for all male Medicare beneficiaries age 50 and older. No deductible and no copay apply to the annual preventive screening. If the test is ordered because you have symptoms, the 2026 Part B deductible ($283) and 20% coinsurance apply instead.

Does Medicare Advantage cover PSA tests?

Yes. All Medicare Advantage (Part C) plans are federally required to cover the same preventive services as Original Medicare, including the annual PSA test, at $0. Network restrictions may apply: HMO plans require you to use in-network providers and labs. PPO plans give more flexibility but may charge more for out-of-network services.

What is the PSA test and why does Medicare cover it?

PSA (prostate-specific antigen) is a protein produced by the prostate gland. Elevated PSA levels in a blood test can indicate prostate cancer, benign prostatic hyperplasia (BPH), or prostatitis. Medicare covers it annually as a prostate cancer screening preventive benefit under Section 1861(oo) of the Social Security Act, recognizing prostate cancer as a leading cancer threat to men.

At what age does Medicare start covering PSA tests?

Medicare covers the annual PSA test starting at age 50. There is no upper age limit in Medicare's coverage rules. This is broader than the USPSTF Grade C recommendation, which focuses on shared decision-making for men ages 55 to 69 and advises against routine screening for men 70 and older.

Is the digital rectal exam (DRE) also covered by Medicare?

Yes. Medicare covers a digital rectal exam (DRE) annually as part of the prostate cancer screening benefit at $0 for men age 50 and older enrolled in Part B. The DRE and PSA are often ordered together at the same visit.

What does Medicare pay for a PSA test when I have symptoms?

When a PSA test is ordered because you have symptoms (urinary problems, pelvic pain, or other prostate-related complaints), Medicare classifies it as diagnostic rather than preventive. In 2026, you pay the Part B deductible of $283 first (if not already met), then 20% of the Medicare-approved lab amount. Medigap Plan G covers both the deductible and the 20% coinsurance.

How often will Medicare pay for a PSA test?

Medicare covers one PSA test every 12 months as a preventive screening benefit. The 12-month period is measured from the date of the last covered screening. If your doctor orders a second PSA test within 12 months for diagnostic reasons (symptoms or follow-up on an abnormal result), it will be processed as a diagnostic test with standard Part B cost-sharing.

What should I do if Medicare billed me for a preventive PSA test?

If your Explanation of Benefits (EOB) shows charges for a PSA test that was supposed to be preventive screening, first check whether the test was coded correctly by contacting your provider's billing department. Ask them to verify the claim used the preventive screening billing code. If the coding is wrong, request a corrected claim submission to Medicare. You can also call 1-800-MEDICARE (1-800-633-4227) to report billing discrepancies.