Does Medicare Cover a Second Opinion? 

Getting a second opinion regarding your health care means that you see a second, or third, physician or specialist after getting an initial diagnosis or treatment plan for a medical condition. Not only is it smart to have another physician weigh in on your health, but it’s also quite a common practice in the United States. You might decide to seek another medical opinion for many reasons, including:

• Your physician isn’t sure about a medical condition even though he suspects something’s wrong. 
• You’d like to look into different treatment options. 
• You’ve received a rare or unusual diagnosis. 
• You want the opinion of a specialist.
• You don’t agree with the initial diagnosis or treatment provided by the first physician. 
• You are worried about the risks of your condition or the treatment options. 

You can benefit from a second opinion by understanding all available treatment options, feeling reassured that you’ve explored every option, or even discovering that the first diagnosis was wrong. 

Does Medicare cover second opinions? 

Original Medicare Part B (medical insurance) covers a second opinion provided by a physician who accepts Medicare assignment in the following instances:

• For medically necessary surgical procedures
• For a major diagnosis
• For a treatment procedure that isn’t an emergency 

Medicare Part B also covers a third opinion if the first and second ones differ. On the other hand, Medicare doesn’t pay for second opinions for medical services that aren’t included in Medicare coverage, like cosmetic procedures. 

When you are visiting a physician for a second opinion, any additional testing you need is covered by Medicare Part B if they are medically necessary (and if the physician accepts Medicare assignment). If your second or third opinion is covered by Original Medicare Part B, you pay 20 percent of the final approved amount after meeting your Part B deductible for the year, and Medicare pays 80 percent of this cost.

If you have coverage through a Medicare Advantage (MA) plan, your provider is required to provide the same benefits as Original Medicare Parts A and B. However, depending on the type of MA plan you have, you may need to use network providers for your health care services to get your benefits. You may also need a referral from your primary care provider to see a specialist, so check your policy or contact your provider for information if you aren’t sure whether you have any coverage restrictions. How much you pay for coinsurance for visits to physicians or specialists for second or third opinions also depends on the type of Medicare Advantage plan you have.