Getting a Second Opinion: How Medicare Covers It and Why You Should

Before undergoing surgery or accepting a serious diagnosis, getting a second opinion is one of the most important things you can do for your health. Medicare covers second opinions -- and in some cases, third opinions -- because the evidence shows they lead to better outcomes and sometimes avoid unnecessary procedures.

Medicare Part B covers second opinions for surgery at the same rate as other Part B services -- 80% of the Medicare-approved amount after the Part B deductible. You pay the remaining 20%.

If the second opinion differs from the first, Medicare also covers a third opinion.

Covered second opinion services:

• Consultation with a specialist about a recommended surgery
• Second opinion on a serious or complex diagnosis
• Review of pathology reports or imaging
• Consultation before major medical procedures

Studies consistently show that second opinions change the diagnosis or treatment plan in a significant percentage of cases:

• A Mayo Clinic study found that 88% of patients who sought a second opinion received a new or refined diagnosis
• Research on cancer diagnoses found that second opinions changed the diagnosis in 10-15% of cases
• For elective surgery, second opinions result in a different recommendation (non-surgical treatment or different surgical approach) in 20-30% of cases

For major surgery, a serious diagnosis, or a treatment plan you're uncertain about, a second opinion is almost always worth pursuing.

Always consider a second opinion when:

• You've been recommended for major surgery
• You've received a serious diagnosis (cancer, heart disease, neurological condition)
• Your symptoms don't match the diagnosis
• The recommended treatment has significant risks or side effects
• You're not improving with the current treatment
• You feel uncertain or uncomfortable with the recommendation

Especially important for:

• Cancer diagnoses -- treatment protocols vary significantly between oncologists
• Orthopedic surgery -- many joint replacements and back surgeries can be avoided or delayed
• Cardiac procedures -- stent placement and bypass surgery recommendations vary
• Neurological conditions -- complex diagnoses benefit from specialist review

1. Ask your doctor for a referral Most doctors support second opinions and can refer you to an appropriate specialist. If your doctor discourages a second opinion, that itself is a red flag.

2. Seek a specialist at an academic medical center For serious conditions, consider seeking a second opinion at a major academic medical center or cancer center. These institutions see high volumes of complex cases and often have the most current expertise.

3. Bring your records Bring all relevant records -- imaging, pathology reports, lab results, and your current doctor's notes. This allows the second opinion physician to give you an informed assessment without duplicating tests.

4. Be honest about seeking a second opinion You don't need to hide that you're seeking a second opinion. Most physicians respect patients who advocate for themselves.

Medicare Advantage plans must cover second opinions at least as generously as Original Medicare. Some MA plans require referrals for specialist visits -- check your plan's rules before scheduling a second opinion.

If your MA plan requires a referral and your PCP is reluctant to provide one, you have the right to request a referral for a second opinion.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.