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Second Opinion Medicare Coverage

Are you facing a significant medical decision or risky surgery? If so, you may be thinking of asking for a second opinion from another set of doctors. That could be costly. You may be unsure if you’ll have to pay out of pocket for that coverage.

Does Medicare cover second opinions? It’s possible, but it’s important to know what your medical options are and that you’re making the right decision for your care. Here’s what you need to know about Medicare second opinion coverage.

Medicare will typically cover the cost of second opinions in limited situations. Most often, it only applies when your doctor recommends that you have surgery or another major diagnostic or therapeutic procedure.

This type of coverage falls under your Medicare Part B coverage. Keep in mind that the full cost is not covered. Most often, you will still need to pay 20% of the cost of the appointment.

Medicare Advantage Coverage

Will Medicare pay for a second opinion if you have Medicare Part C? Possibly, depending on your plan. Part C — also known as Medicare Advantage — comes from a private provider that Medicare approves. Because it is different from parts A and B, it can have different coverage options and policy features. 

Medicare Advantage can cover second opinions, but your policy details may be different from what Medicare Part B offers. Keep in mind that the cost of Medicare second opinion coverage may differ with a Medicare Advantage plan. It’s important to check with your plan directly to determine the deductible and copayment or coinsurance amount for your second opinion.

What About a Third Opinion?

Sometimes, doctors provide two dissimilar approaches to care. When you have a second opinion that offers a radically different treatment option, you could be left unsure of what to do. A third opinion may be beneficial to determine which route to take.

Medicare can cover the cost of a third opinion. This is only likely to happen if the first two doctor’s opinions are significantly different.

When Does Medicare Not Cover a Second Opinion?

Keep in mind that Medicare will not pay for second opinions for services it does not typically cover. That could include:

  • Alternative medicines

  • Cosmetic surgeries

  • Vision care

  • Dental care

  • Long-term care

Medicare is not likely to cover second opinions for non-serious conditions. It’s always important to verify if your plan will cover a second opinion by calling your provider or reaching out directly to Medicare for specific plan information.