Sunday October 1, 2023
Does Medicare Cover Getting a Second Medical Opinion?
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, then the second opinion 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 that 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 that 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 the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Published September 29, 2023
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