Does Medicare Cover Second Opinions? What You Need to Know

Medicare Does Cover Second Opinions

Medicare covers second opinions for many services, including elective surgeries and certain procedures, under Part B with standard cost-sharing. The program treats a second opinion as a standard physician visit, subject to deductibles and coinsurance.

What Medicare Covers for a Second Opinion

Original Medicare (Part B) generally pays for a second opinion from a doctor who accepts assignment. This applies when you face a decision about a diagnostic test, surgery, or other major procedure. Medicare Advantage plans must also cover second opinions, though their rules and network requirements may differ. The second opinion doctor reviews your records, examines you, and provides a written report.

Cost-Sharing and Your Responsibility

For Part B second opinions, you pay 20% of the Medicare-approved amount after meeting your Part B deductible. If the doctor does not accept assignment, your share can be higher. Medicare Advantage plans have their own copays or coinsurance, which may be lower than Original Medicare's structure.

Getting a Second Opinion Under Medicare

• Confirm the doctor accepts Medicare assignment.
• Ask your primary care provider for a referral if your plan requires one.
• Gather your medical records, imaging, and test results to share with the second-opinion provider.
• Verify coverage details with Medicare or your plan before the visit.

When a Second Opinion May Not Be Covered

Medicare generally does not cover second opinions for routine or non-diagnostic services. Elective cosmetic procedures and services deemed not medically necessary fall outside coverage. If a second opinion leads to a different treatment plan, the follow-up care is covered as standard medical care under Medicare's usual rules.