How to Get a Second Opinion with Medicare
Key takeaways:
Medicare beneficiaries have the right to a second opinion before a medically necessary procedure like surgery.
Medicare Part B covers 80% of the cost of the visit, after you meet your deductible.
Medicare Advantage plans will also help cover the cost of a second opinion, though the requirements will vary depending on your specific plan.
Making informed decisions about your health can help you feel empowered and confident in the quality of care you’re receiving.
If your provider recommends a medically necessary procedure, like surgery, you may want to get a second opinion before proceeding. If the second opinion confirms your original provider’s recommendation, this can help you feel more positively about the procedure. If the opinions differ, you’ll have access to more information that can help you make the right decision for your needs.
With Medicare, you have the right to a second opinion before a medically necessary procedure. Medicare Part B will cover 80% of the approved amount after you meet your deductible. Medicare Advantage plan beneficiaries are also guaranteed the right to a second opinion, though the specifics will vary according to your plan.
In this article, we’ll explain when Medicare helps to pay for a second opinion, how to find a new provider, the costs of these visits, and how to prepare for them.
When will Medicare pay for a second medical opinion?
Yes, Medicare Part B will cover a second opinion if your provider recommends a non-emergency, medically necessary procedure, like surgery.
To get a second opinion in this scenario, you don’t need a referral or order from your provider. You can search independently for another provider or ask your current provider for their recommendations. You can also visit Medicare.gov/care-compare to find providers that accept Medicare.
Some experts advise searching for a provider affiliated with a different hospital or practice than your original provider when looking for a second opinion.
If the second opinion differs from your original provider’s recommendation, Medicare Part B will also cover a third opinion.
Keep in mind that Medicare will not cover second opinions for elective and non-medically necessary procedures, including cosmetic procedures.
How much will Medicare pay for a second opinion?
With Medicare Part B, you’ll pay just 20% of the Medicare-approved amount of the second opinion after you meet your deductible. You’ll also pay 20% of the Medicare-approved amount for a third opinion, if necessary.
The exact amount you’ll owe will vary depending on several factors, including:
How much the provider charges
The type of facility
Other insurance you may have
If the second provider recommends additional testing during your visit, Medicare will help pay for these services.
Which parts of Medicare cover second opinions?
If you have Original Medicare, Part B covers 80% of the Medicare-approved cost of the opinion after you meet your deductible.
Medicare Advantage (Part C) plans will also help cover the cost of a second opinion, but the requirements may differ depending on the type of plan you have. Some Medicare Advantage plans will only help cover the cost of a second opinion if you:
Have a referral from your primary care provider
Seek a second opinion from a provider in your plan’s provider network
Medicare Advantage plans will also help cover the cost of a third opinion if the first two opinions differ. For more information about your Medicare Advantage plan and its coverage of second and third opinions, contact your plan provider for more information.
What do I need to prepare before getting a second opinion?
Once you’ve found a provider and made an appointment for your second opinion, be sure to ask your original provider to send all of your medical records to the new provider. If possible, give the new provider’s office a call to ensure that they have access to your records ahead of time.
It’s also a good idea to write down all the questions you’d like to ask the new provider. Keep note of the answers and recommendations your original provider made so that you can easily compare and contrast the two opinions.
If you feel comfortable, ask a friend or family member to go with you to the appointment. They can provide moral support while ensuring that you are advocating for your needs and questions.
What do I do after getting a second opinion?
If the two opinions differ, consider consulting a third provider for a third opinion. You may also want to circle back with your original provider to share the new provider’s insights to see if that changes their recommendations.
Seeking second or third opinions does not mean you have to switch providers. If you choose to move forward with the procedure or surgery, you get to choose which provider you want to work with.
Bottom line
Getting a second opinion before surgery or therapeutic procedure can help to ensure that you’re making an informed decision about your health.
With Medicare, you have the right to a second opinion before medically necessary procedures. Medicare Part B will cover 80% of the approved amount of the second opinion after you meet a deductible. If the second opinion differs from the first, it will also cover 80% of the cost of a third opinion. Medicare Advantage beneficiaries also have the right to a second opinion, though the requirements and cost will vary depending on the specific type of plan you have.
Sources
Second surgical opinions. (n.d.). Medicare. https://www.medicare.gov/coverage/second-surgical-opinions
Centers for Medicare & Medicaid Services. (2021). Getting a second opinion before surgery (Healthcare Information CMS Product No. 02173). https://www.medicare.gov/publications/02173-getting-a-second-opinion-before-surgery.pdf