Does Medicare Cover Second Opinions?

Learn if you have to pay completely for your second opinion

by Amy De Vore+ on Jul 23, 2015 | 12 Comments

Before you get non-emergency surgery you may want to get a second opinion, but does Medicare cover that? That’s the big question. Going under the knife can be scary, and we all want to make sure we’re diagnosed properly before we do it. Find out if you have to pay to talk to another “Doc.”

Does Medicare cover Second Opinions?

Medicare Part B (and only Part B) will cover second opinions before non-emergency surgery. You will still have to pay for your deductible ($185), copays, and coinsurance. 


Just for the record Medicare will pay for a third opinion if it turns out that your first and second opinions are different.  Also these opinions should be covered even if the surgery or other procedure is determined not to be covered.

Does Medigap Cover Second Opinions?

All Medigap plans pay part or all of your Medicare approved second opinion, but only Medigap C and F will cover your Part B deductible.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Second Opinions?

While Medicare Advantage must cover everything that Medicare covers, it can vary in how it covers it. Plus, since most Medicare Advantage plans are HMOs, you may have to be approved by your primary care physician before seeking a second opinion from a specialist.

Learn More about Medicare AdvantageGet a MA Quote

For further questions call a Senior65 agent at 800-930-7956.

Print Friendly Version

Reader Comments and Questions

(Click here to leave a comment)

By Bogdan on November 20, 2018

I had both hips replaced in 2009 with DePuy metal-on metal which have been recalled since they leak Cobalt and Chromium ions in the blood (Metallosis). Two weeks ago I saw the Surgeon who did the original surgery and asked if I need a Revision surgery. His answer was NO since the Revision risks outweigh the benefits. Knowing that Metallosis is also highly poisoning, I would like to get a Second opinion about getting a Revision or not. Will Medicare pay for a Second opinion in my case? Thank you, Bogdan

Bogdan,
Since Medicare Part B will cover second opinions before non-emergency surgery, Medicare should pay for you to seek the feedback of another doctor. If you are not sure, please contact Center for Medicare Services (CMS) directly.


By Michele on April 13, 2018

I have cancer and was told to call Hospice. I would like to go to Dana Farber Cancer treatment center. And see if there is anything more they can do Since my Oncologist threw in the towel. Will my medicare cover me to do so. Since I'm not with this Oncologist anymore

Michele,
Sorry for the serious diagnosis. We suggest you contact the Center for Medicare Services at 1-800-633-4227 ASAP to discuss your specific rights and next steps.
Be well,
-Amy at Senior65.com


By Ken on February 11, 2018

I have been told that I have severe COPD by one of by doctors when I went on Medicare. I saw another doctor when I was sick with a cold and they were confused when I told them about the COPD since my lungs sounded clear. Will my Medicare pay for a second opinion? Thanks

Medicare's second opinions are generally for surgery. Contact CMS at 1800 MEDICARE to see if you have any options in your case.
-Michelle at Senior65.com


By Grannibug on May 12, 2017

I have had a mammogram, ultrasound and MRI of my left breast. My Dr. says all is fine, no cancer. But, I still have blood coming from my left breast. I am very concerned. Will medicare pay for a second opinion?

Grannibug,
Medicare's second opinions are generally for surgery. However, we suggest you contact Medicare directly to see if they will cover you due to your specific situation.
-Amy from https://www.senior65.com/


By LUANN DARNELL on March 17, 2017

I have had an MRI, CT scan and PET scans, and am getting a biopsy of a lung mass. Looks like cancer. If that is the verdict, I would like to move to a top-notch cancer hospital (M D Anderson), and am wondering if my Medicare and supplement will cover starting with them as a second opinion. Not sure if they would require repeating these scans, which would be very costly if not covered. The scans show involvement in the bones in the neck, spine, pelvis and femur.

Luann,
If a hospital or doctor accepts Medicare assignment then you are covered by both Medicare and your supplement, and should be able to seek a second opinion. If you have Medigap Plans F or G, which cover Part B excess charges, you can see a doctor that does not accept assignment, but agrees to work with you, and your plan will cover 100% of the costs (you may initially need to pay out of pocket). As always, you will want to confirm with Medicare how your services are covered.
-Michelle from https://www.senior65.com/


By Carol Steffy on January 26, 2017

I have had a lumpectomy for breast cancer. Now the oncologist is recommending chemotherapy and hormonal treatment. Will Medicare pay for a second opinion about the best treatment plan.

Carol,
You will contact Medicare directly to find out specific coverage.
-Michelle from https://www.senior65.com/


By frank on January 17, 2017

For the last 2-3 months I have been suffering with a neuropathy in both lower limbs. I've sought treatment and a diagnosis at Northwestern Hospital (Chicago). To date I've had over sixty tests/labs and no specific diagnosis or stated cause for the neuropathy. I'd like to contact the Mayo Clinic to review my situation and hopefully determine a cause and a treatment based on that determination. Will this be covered under Medicare?

Frank,
You will want to check with the Mayo Clinic and Medicare to confirm coverage.
-Amy from https://www.senior65.com/


By Margie Spillers on September 21, 2016

I had a first and second opinion telling me that I need to have lumbar surgery, but their recommendations for the type of surgery were very different: one was outpatient and the other involved a 4 day hospital stay for a spinal fusion. Does Medicare pay anything for a third opinion? Do you agree that I need a third opinion?

Margie,
Usually, Medicare allows for a third opinion, if your first two are in disagreement. We suggest contacting Medicare, since they both agree on the need for surgery, but disagree on how it should performed. Wishing you the best of luck!
-Michelle from https://www.senior65.com/


By Mary Ann Cotter on June 12, 2016

Does Medicare cover a second opinion in reference to scheduling a colonoscopy. I did not feel comfortable with the doctor I visited. Thanks

Mary Ann,
Medicare provides for second opinions before surgery. Since many colonoscopies are considered surgery, you most likely should be able to get a second opinion, and possibly a third, if the 1st and 2nd doctor have different diagnoses. Hope this helps!
-Amy from https://www.senior65.com/


By Milton Hardy on June 08, 2016

I have already had surgery 3 mos. ago for Dupuytrens Contracture and Carpel Tunnel! I am still in pain and still have stitches the physician neglected to remove ... to boot, not only has the contracture not been corrected, but three other fingers which were straight prior to surgery are now bent and also in pain. I need a second opinion on what's already been done as well as my left hand corrected. (I am both a pianist and an artist). I have Medicare Parts A,B, & D as well as a medigap policy .I do not at this point trust the present physician to continue any further ... it has been a little over 3 months since the surgery, the pain won't even let me get a night's sleep. Does Medicare cover a second or maybe even a third opinion?

Milton,
Medicare Part B and Medigap cover second opinions before surgery, if the first and second opinion are in opposition, you can get a third opinion. Since, a surgical procedure has alread been performed, you should be allowed to see any doctor you want for follow up treatments. Hope this helps!
-Michelle from https://www.senior65.com/


By Rachel Tanenbaum on August 13, 2015

If I have Medigap, I won't have to pay anything for my second opinion? That seems pretty good to me. Am I missing something?

Rachel, With Medigap C or F, you should have no out of pocket costs for a second opinion before non-emergency surgery; however, if you have any of the other plans you would pay the Part B deductible, plus you could have to part of your Part B copays and coinsurance.
-Jacima from https://www.senior65.com/


By Bryce M. on July 24, 2015

Will I always get a second opinion? I've been told that I need thyroid surgery, but I would like a second opinion and I didn't realize I could have that covered.

Bryce,
While Medicare says that it offers second opinions, you will want to check with Medicare to see if they offer a second opinion for your thyroid surgery.
-Chris from https://www.senior65.com/



Leave a Question or Comment Below

If you would like to receive an instant answer, try our new answerbot

If you are already working with an insurance agent, please direct your question to him or her.

If you do not have an agent (or you are unsatisfied with your agent's knowledge or service), shoot us your Medicare insurance question below and consider enrolling in a plan through Senior65! For more check out "Why work with Senior65?"

PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.












We will not publish your last name or email if you submit this form.



It's 100% FREE to work with Senior65

Call our licensed agent today at 800-930-7956. Click here to learn 5 great reasons to work with Senior65.com