Medicare and Second Opinions Before Surgery
Key Takeaways
Medicare Part B covers second opinions.
Medicare Advantage plans also cover second opinions.
If the second doctor orders additional tests, Medicare coverage applies.
When the second doctor disagrees with your primary doctor, Medicare will even cover a third opinion.
Opting for surgery is a big decision. You trust your regular doctor, but you may have more questions about your treatment options. Asking another expert for advice can give you a different perspective and help you make a more informed decision. So does Medicare pay for second opinions? In most cases, Medicare Part B and Medicare Advantage plans cover second opinions on your diagnosis or treatment plan.
How Do I Get a Second Opinion with Medicare?
If you have several treatment options, or you’re not confident in your diagnosis, you can get a second opinion. All you have to do is ask. Talk to your doctor at your next appointment, and ask them to refer you to another doctor. They can give you a recommendation and send your health records to the second doctor.
What is a Second Opinion?
A second opinion is when another doctor reviews your diagnosis and gives you their treatment recommendations. Sometimes they will agree with your regular doctor, or they may have another option for you to consider. After the second opinion, you can go back to your regular doctor and follow their treatment plan, or you can continue with the new doctor.
A second opinion includes:
- Reviewing your medical history
- Verifying your current diagnosis
- Performing a physical exam or ordering additional tests
- Talking about your recommended treatments, and helping you weigh the options
This consultation can help you explore other possible diagnoses, and give you peace of mind when choosing a treatment option.
When Should I Ask for a Second Medical Opinion?
You can request a second opinion anytime you’re not 100% confident in your treatment plan or diagnosis. It’s often a good idea to get a second opinion before surgery. There’s a risk of complications, and you’ll need to anticipate downtime while you’re recovering. If you aren’t sure that surgery is the right option, ask for a second medical opinion. After all, it’s up to you to decide if you will go ahead with surgery.
You can ask for a second opinion when:
- Your doctor recommends surgery as one of your treatment options.
- You’re considering an invasive treatment option.
- The recommended procedure is high risk.
- You have a cancer diagnosis.
- Your condition is rare.
- Your current treatment plan isn’t working.
There are times you shouldn’t wait for a second opinion. If you’re having a medical emergency, there might not be time to get a second opinion. In emergencies, it’s best to follow the treatment recommendations from the doctor who sees you.
How Should I Prep for a Second Opinion Appointment?
There’s a lot to cover during a second opinion appointment, so it’s a good idea to come prepared.
The second doctor will have your medical records, but be ready to answer detailed questions about your medical history and your current condition. You’ll also want to tell the doctor what your primary doctor recommended, and why.
Write down a list of questions you want to ask the doctor. You can also bring a friend or family member to the appointment. They can ask more questions, take notes, and help you remember what the second doctor says.
Does Medicare Pay for a 2nd Opinion?
So will Medicare cover second opinions? The good news is that Medicare covers most second opinions. [i] This helps you make an informed decision about your treatment options. Both Medicare Part B and Medicare Advantage plans cover second opinions.
Before you book a second opinion, make sure the second doctor accepts your Medicare coverage. Your plan only covers second opinions from in-network providers.
Medicare Part B
Medicare Part B covers second opinions before surgery. You can have a second doctor review your options and give their thoughts on your treatment plan. Part B deductibles still apply. After you’ve reached your yearly deductible limit, Medicare will pay for 80% of the second opinion. You’ll pay the 20% coinsurance.
Sometimes the second doctor will order additional tests. Medicare will cover 80% of these tests, just like any other covered services.
Medicare Advantage
Does insurance cover second opinions? Private insurance companies offer Medicare Advantage plans. These plans offer the same coverage as Part B, including second opinions.
Medicare Advantage plans have different monthly premiums and lower out-of-pocket costs than Medicare Part B. But each plan is a bit different, so check with your provider before booking a second opinion. Some Advantage plans will only cover second opinions if you have a referral from your primary doctor so make sure you know what to expect.
Call our licensed insurance agents at 1-855-792-0088 TTY: 771 and find out what’s covered in your plan.
When Does Medicare Cover Second Opinions?
Medicare pays for second opinions if the surgery or treatment plan is medically necessary. This includes operations that will save your life. Your Original Medicare coverage also pays for treatment plans that improve your quality of life.
Medicare doesn’t cover surgery or consultations that are not medically necessary. For example, if you’re getting cosmetic surgery, Medicare will not pay for the second opinion or the surgery. [i]
Does Medicare Cover Third Medical Opinions?
In some cases, Medicare will even cover third opinions. If the first two doctors didn’t agree on your treatment options and you’re not sure what treatment is best for you, you can request a third opinion. Think of it as a tie-breaker. Medicare Part B also pays 80% of third opinion appointments.
