Quick Answer
Yes. Medicare covers stroke treatment and rehabilitation, including inpatient hospital care (Part A), outpatient therapy (Part B), skilled nursing facility care, durable medical equipment like walkers, and prescription medications (Part D). The average first-year rehabilitation cost exceeds $17,000.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Original Medicare (Part A) | Covered | Inpatient hospital care and rehabilitation up to 90 days |
| Original Medicare (Part B) | Covered (80%) | Outpatient therapy, DME at 80% after deductible |
| Medicare Advantage | Covered | Special Needs Plans available for stroke survivors |
| Medigap | Covers Cost-Sharing | Covers deductibles, coinsurance, and SNF costs |
| Medicare Part D | Rx Coverage | Covers stroke prevention and treatment medications |
Understanding Your Coverage Options
Original Medicare (Part a & B)
Medicare Part B covers one PSA blood test every 12 months for men age 50 and older as preventive care. There is no deductible or coinsurance for this annual screening - it is completely free.
Part B also covers digital rectal exams annually. If your doctor deems additional PSA tests medically necessary (such as follow-up screenings), Part B will cover those as well, though standard cost-sharing may apply.
For prostate surgery, Part A covers inpatient procedures and Part B covers outpatient surgical procedures. You are responsible for the applicable deductibles and coinsurance.
What It Covers
- Annual PSA blood test (age 50+) at $0
- Annual digital rectal exam
- Prostate biopsy when medically necessary
- Inpatient prostate surgery (Part A)
- Outpatient prostate procedures (Part B at 80%)
What It Doesn't Cover
- PSA tests before age 50 (unless medically necessary)
- Elective or non-medically necessary repeat screenings
Annual PSA screening: $0. Treatment costs: Part A deductible $1,736 (2025); Part B 20% coinsurance after $283 deductible.
Medicare Advantage (Part C)
Medicare Advantage plans must cover all preventive services that Original Medicare covers, including annual PSA tests at no cost. Many plans also include additional preventive benefits.
For prostate surgery and treatment, Medicare Advantage plans cover the same services but may have different cost-sharing structures, network requirements, and may require referrals to specialists.
Medicare Supplement (Medigap)
Since the annual PSA screening is already free under Part B, Medigap provides no additional benefit for the screening itself. However, for prostate treatment and surgery, Medigap plans cover the cost-sharing amounts - including the Part B 20% coinsurance and Part A deductible.
A comprehensive Medigap plan like Plan G can significantly reduce out-of-pocket costs for prostate cancer treatment.
Medicare Part D
Medicare Part D covers prescription medications for prostate cancer treatment, including hormone therapy drugs and other cancer medications. Your costs depend on your plan's formulary and the tier your medications fall under. Always verify your medications are on the plan formulary before enrolling.
PSA Test & Prostate Care Cost Estimates
| Service | Cost Without Insurance | Cost With Medicare |
|---|---|---|
| Annual PSA screening | $100 – $300+ | $0 (preventive) |
| Digital rectal exam | $50 – $200 | $0 (preventive) |
| Prostate biopsy | $1,500 – $3,000 | 20% coinsurance after deductible |
| Prostate surgery (inpatient) | $10,000 – $50,000+ | Part A deductible + coinsurance |
| Follow-up PSA tests | $100 – $300 | 20% coinsurance if medically necessary |
✦ Important Exceptions & Limitations
Age Requirement for Free Screening
Free annual PSA screening begins at age 50. Men under 50 may receive coverage only if a doctor deems the test medically necessary.
Frequency Limit of Once per 12 Months
Medicare covers one PSA screening every 12 months. Additional tests within the same year require a medical necessity determination from your doctor.
Doctor Must Accept Medicare Assignment
To receive full Medicare benefits for PSA testing, your doctor must accept Medicare. If they don't, you may be responsible for additional charges.
Follow-up Costs May Apply
While the annual screening is free, follow-up tests, biopsies, and treatments are subject to standard Part B cost-sharing (20% coinsurance after deductible).
Medicare Advantage Network Rules Apply
If you have a Medicare Advantage plan, you must use in-network providers for PSA testing and prostate care to receive the lowest costs.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed Medicare expert and member of the Forbes Finance Council who has been helping beneficiaries navigate their Medicare options.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare.