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Does Medicare Cover Second Opinions?


Dear Marci,

My doctor is recommending I get surgery. I do trust them but I want to get another opinion before agreeing to something so big. Will Medicare cover a second opinion, even if another doctor recommends the same thing?

-Rana (El Paso, TX)


Dear Rana, For our other readers, a second opinion is when you ask a doctor other than your regular doctor for their view on symptoms, an injury, or an illness you are experiencing in order to better help you make an informed decision about treatment options.  There are countless reasons why someone would want a second opinion, but here are just a few examples:

  • You have a rare condition with which another doctor may have more experience or training.

  • Your doctor recommends a treatment that is risky, invasive, involves surgery, or has lifelong consequences.

  • You want assurance that you’ve considered all treatment options.

  • You believe your diagnosis could be incorrect.

Original Medicare covers second opinions if a doctor recommends that you have surgery or a major diagnostic or therapeutic procedure. Medicare will also cover a third opinion if the first and second opinions are different from each other. The second and third opinions will be covered even if Medicare will not ultimately cover your procedure. Do note, however, that Medicare does not cover second and third opinions for excluded services, such as cosmetic surgery.    If you have a Medicare Advantage Plan, your plan may have different cost and coverage rules for second and third opinions. Contact your plan for more information about costs and restrictions.   Some people may feel uncomfortable or nervous asking their doctor for a second opinion. Doctors are professionals and most will respect your want for a second opinion. Many consider it standard medical practice to get another opinion. In fact, your doctor may even be ready to give you referrals for a second opinion. Trust yourself and remember that you are your strongest advocate! -Marci


Article Submitted by:

Stephanie Kirk, Owner JC Madison Inc.

360-779-1082

18887 State Highway 305, Poulsbo, WA



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