Medicare Part B typically covers a diagnostic prostate biopsy if it’s deemed medically necessary by a doctor. Part B also covers certain yearly preventive prostate cancer screenings.
Medicare Advantage (Part C) plans also cover prostate biopsies if they are deemed medically necessary by your doctor in order to diagnose potential prostate cancer.
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Medicare Part B generally pays 80 percent of the Medicare-approved amount for covered doctor services, such as a medically necessary prostate biopsy.
You typically pay the remaining 20 percent after you meet your Part B deductible. In 2020, the Part B deductible is $198 per year.
Medicare Part B also covers two other types of prostate cancer screenings:
These preventive screenings are covered by Medicare Part B once every 12 months for men over the age of 50.
You typically pay 20 percent of the cost of your digital rectal exam (plus your doctor’s fees) after you meet your Part B deductible.
You pay nothing for your yearly PSA blood test if your doctor accepts Medicare assignment. If your doctor accepts assignment, this means he or she agrees to accept the Medicare-approved amount as full payment for covered services.
A PSA test or digital rectal exam are not the same thing as a prostate biopsy. We recommend speaking with your doctor or health care provider about specific costs and to find out if your biopsy will be covered.
Medicare Advantage plans are sold by private insurance companies as an alternative to your Original Medicare (Medicare Part A and Part B) benefits.
Every Medicare Advantage plan must cover the same hospital and medical costs as Medicare Part A and Part B. If your prostate biopsy is covered by Original Medicare, it is also covered by Medicare Advantage.
In addition to these standard Part A and Part B benefits, many Medicare Advantage plans offer additional benefits that aren’t offered by Original Medicare.
Some of these extra benefits may include one or more of the following:
Not all plans offer some or any of these benefits. Plan availability can vary by location.
A licensed insurance agent can help you find Medicare Advantage plans in your area so that you can find a plan that works for you.
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Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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