October 05, 2023

Does Medicare cover getting a second medical opinion?

By Jim Miller/via Crescendo
Planned Giving
Does Medicare cover getting a second medical opinion?
Does Medicare cover getting a second medical opinion?

Medicare will pay for a second opinion if your current doctor has recommended surgery or some other major diagnostic or therapeutic procedure.

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The doctor I currently see thinks I need a knee replacement, but I would like to get some other treatment options before I proceed. Does Medicare cover second medical opinions?

Medicare will pay for a second opinion if your current doctor has recommended surgery or some other major diagnostic or therapeutic procedure. A second medical opinion from another doctor may offer you a fresh perspective and additional options so you can make a more informed decision. If the second opinion agrees with your current doctor's opinion, it will give you reassurance.

If you are enrolled in original Medicare, 80% of the costs for second medical opinions are covered under Part B (you or your Medicare supplemental policy are responsible for the other 20%). You do not need an order or referral from your doctor to get the second opinion. If the first two opinions differ, Medicare will pay 80% for a third opinion.

Most Medicare Advantage plans also cover second opinions, but you may need to follow certain steps to get the expenses covered. For example, some plans will only help pay for a second opinion if you have a referral from your primary care doctor. They may also require that you consult with a doctor in their designated network. If you are enrolled in a Medicare Advantage plan, familiarize yourself with their specific guidelines.

Finding Another Doctor To find a qualified doctor for a second opinion, you may ask your doctor or another trustworthy physician for recommendations. You also have the option to independently search for one.

Whatever you choose, it may be best to go with a doctor who is affiliated with a different practice or hospital than your original doctor. Hospitals and practices can be uniform when it comes to treatment recommendations, and doctors from the same group are likely to offer similar advice.

If you choose to find a doctor on your own, consider using Medicare's Care Compare tool at Medicare.gov/care-compare or call (800) 633-4227. This tool will help you find doctors by name or medical specialty in your area who accept original Medicare. If you are enrolled in a Medicare Advantage plan, call or visit your plan's website to obtain a list of candidates. After you have a few doctors' names, there are free online resources to help you research their background and credentials.

Once you decide on the second doctor, ask your current doctor's office to send your medical records to the second doctor, and follow up to ensure the records arrive before your appointment. Sometimes you may have to pick up a copy of your records and deliver them yourself. Ensuring the second doctor has your records will help avoid having to repeat tests you have already done. If the second doctor wants to perform additional tests, Medicare will help pay for those tests.

For more information, see the Medicare publication "Getting a Second Opinion Before Surgery" at Medicare.gov/publications – type in 02173 in the Keyword or Product Number box.

“Savvy Living” is written by Jim Miller, a regular contributor to NBC’s “Today Show.” The column, and others like it, is available to read via The American Legion’s Planned Giving program, a way of establishing your legacy of support for the organization while providing for your current financial needs. Learn more about the process, and the variety of charitable programs you can benefit, at legion.org/plannedgiving. Clicking on “Learn more” will bring up an “E-newsletter” button, where you can sign up for regular information from Planned Giving.

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