PSA Screening for HIM Act
The PSA Screening for HIM Act would require group health plans and health insurance issuers offering group or individual coverage to cover prostate cancer screening tests (specifically PSA screening) without cost-sharing for men who are at high risk. The bill targets men aged 40 and over who are considered high risk—primarily African-American men and men with a family history of prostate cancer—and adds coverage for additional evidence-based preventive care and screenings for those high-risk individuals. It defines what constitutes a family history and clarifies that nothing in the bill prevents plans from providing additional coverage beyond USPSTF recommendations or excluding non-recommended services. The changes would take effect for plan years beginning on or after January 1, 2025. In short, the bill aims to remove out-of-pocket costs for PSA testing for high-risk men and expand preventive coverage for this group, with the goal of earlier detection and reduced mortality from prostate cancer, while preserving flexibility for broader coverage decisions by plans.
Key Points
- 1Requires no-cost PSA screening coverage for men aged 40+ who are at high risk (e.g., African-American men and men with a family history of prostate cancer).
- 2Adds coverage for “additional evidence-based preventive care and screenings” for high-risk men 40+ beyond the PSA test, as long as they are evidence-based.
- 3Defines high-risk status to include African-American men and men with a family history of prostate cancer; specifies what counts as a family history.
- 4Clarifies that plans may also offer coverage for services beyond USPSTF recommendations and may cover non-recommended services if they choose.
- 5Applies to group health plans and health insurance issuers offering group or individual coverage, with the effective date for plan years beginning on or after January 1, 2025.