Does Medicare Cover Second Opinions?
- Occasionally, you may want to seek the opinion of a second doctor if you feel uncertain about the diagnosis of the first one. Here's what you need to know.
Medicare Part B and Medicare Advantage (Medicare Part C) plans both cover second opinions as long as it’s for a service that Medicare typically covers. And in instances where both doctors disagree, Medicare also covers the cost of a third opinion.
You may occasionally find yourself in a situation where your doctor has given you a diagnosis or recommendations that you're unsure of. In these instances, you may want to seek a second opinion from another doctor.
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What Is a Second Opinion?
A second opinion is when you have a second doctor review a treatment plan or a diagnosis that another doctor has given you. A second opinion helps you better understand what options are available to you and whether you’re getting the proper care.
For example, if the first doctor recommends surgery to treat a condition, you may want to seek the opinion of a second doctor to see if surgery is truly the best option. And in cases where both doctors disagree, you may want to seek a third opinion to help determine the best path forward.
When you want to get a second opinion, speak with your primary doctor. You can request that they send your medical records to the second doctor you’d like to consult.
When Does Medicare Cover Second Opinions?
Medicare Part B and Medicare Advantage covers second opinions as long as the initial coverage is covered by Medicare. The only time Medicare doesn’t cover a second opinion is if it’s used to treat or prevent a condition that Medicare does not cover. In this instance, Medicare won’t cover the second opinion or the surgery.
Surgeries are considered medically necessary if they’re being used to treat conditions or prevent a condition from worsening. In the case of cosmetic surgeries, Medicare doesn’t cover the surgery itself or second opinions related to cosmetic issues. Most surgeries are covered by Medicare as long as your doctor deems them medically necessary for your health.
Does Medicare Part B Cover Second Opinions?
Medicare Part B does help pay for a second opinion as well as any additional testing or treatment that may be required, as long as they’re deemed medically necessary. If you have Part B, it pays for 80% of the Medicare-approved amount.
When Should You Ask for a Second Medical Opinion?
It’s important for you to feel comfortable with the prognosis and treatment your doctor provides you. If you’re feeling uncertain about a treatment plan or even a diagnosis from your doctor, you should seek a second opinion. Getting a second opinion can be a good idea when:
- You’ve been diagnosed with a rare condition.
- You’ve been diagnosed with cancer.
- Your doctor recommends surgery or other high-risk procedures.
- You’ve been on a treatment plan for a long period with no improvement to your condition.
The exception to this is during emergencies. If you’re currently experiencing a medical emergency, you should get care from the doctor that’s currently treating you. Don’t wait to get a second opinion if your doctor says you need surgery for something like a blood clot or some other critical condition. It's critical that emergency operations are performed as soon as necessary to protect your health.
Getting a Second Opinion
When you get a second opinion, it’s a good idea to arrive with all the necessary information you would need for the second doctor. Be sure your first doctor has sent over all of your medical records and put together a list of questions you may have for the second doctor.
During your visit, the second doctor will examine you and review your medical records. Keep in mind, they may order different tests from what the first doctor ordered. In these instances, Medicare will cover the costs of any additional testing you may need.
In some cases, the second doctor will come to the same conclusion as the first doctor. In this case, you can continue with the recommended treatments.
In other cases, the second doctor may give you a different diagnosis or treatment recommendation. Depending on what the second doctor says, you have a few options:
- You can choose to receive treatment from the second doctor.
- You can go back to the first doctor and discuss what the second doctor said.
- You can opt to receive a third opinion from another doctor.
If you decide to opt for a third opinion, Medicare provides the same coverage as if you were getting a second opinion.
