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- Cancer Information
For medical questions, we encourage you to review our information with your doctor.
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- Can Prostate Cancer Be Found Early?
- Screening Tests for Prostate Cancer
- American Cancer Society Recommendations for Prostate Cancer Early Detection
- Insurance Coverage for Prostate Cancer Screening
- Signs and Symptoms of Prostate Cancer
- Tests to Diagnose and Stage Prostate Cancer
- Prostate Cancer Stages
- Risk Groups and Lab Tests to Help Determine Risk from Localized Prostate Cancer
- Survival Rates for Prostate Cancer
- Questions to Ask About Prostate Cancer
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- Observation or Active Surveillance for Prostate Cancer
- Surgery for Prostate Cancer
- Radiation Therapy for Prostate Cancer
- Cryotherapy, HIFU, and Other Ablative Treatments for Prostate Cancer
- Hormone Therapy for Prostate Cancer
- Chemotherapy for Prostate Cancer
- Immunotherapy for Prostate Cancer
- Targeted Drug Therapy for Prostate Cancer
- Treatments for Prostate Cancer Spread to Bones
- Considering Treatment Options for Early Prostate Cancer
- Initial Treatment of Prostate Cancer, by Stage and Risk Group
- Following PSA Levels During and After Prostate Cancer Treatment
- Treating Prostate Cancer That Doesn’t Go Away or Comes Back After Treatment
- If You Have Prostate Cancer
- Prostate Cancer Videos
- Prostate Cancer Quiz
Insurance Coverage for Prostate Cancer Screening
The American Cancer Society (ACS) supports legislation assuring that men have insurance coverage for prostate screening exams.
Men should have the option of screening
ACS recognizes that it’s not yet clear whether screening lowers the risk of dying from prostate cancer. Until such time when studies are conclusive, men and their doctors should be free to determine if testing is right for them. Men shouldn’t be prevented from getting prostate cancer screening because of testing costs, lack of health insurance coverage, or lack of access to testing.
ACS doesn’t recommend routine screening for prostate cancer for all men at this time, because we believe proper guidance and education is needed before testing is done. Doctors and other health care providers should help men understand the potential risks and benefits of prostate-specific antigen (PSA) testing, allowing them to make an informed decision on testing.
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.
Medicaid coverage
Medicaid coverage of prostate cancer screening varies by state.
People who qualify for Medicaid based on their state’s decision to expand Medicaid under the Affordable Care Act (ACA) are entitled to the same screening services as people covered by private insurance.
For people who qualify for Medicaid based on other pathways, prostate cancer screening coverage is determined by the state. Most Medicaid programs do cover screening.
To learn more about prostate cancer screening coverage in your state, contact your state’s Medicaid office.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
US Centers for Medicare & Medicaid Services. Your Medicare Coverage: Prostate Cancer Screenings. Accessed at https://www.medicare.gov/coverage/prostate-cancer-screenings on July 11, 2023.
Last Revised: November 22, 2023
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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