Medicare covers second opinions, and in some cases it requires them before you have surgery

Medicare Part B covers a second opinion from another doctor at no extra cost beyond your regular copay or coinsurance. You do not need permission from your first doctor, and you do not need a referral. If your first doctor recommends surgery, Medicare will cover a second opinion — and in some situations, a third opinion as well. The coverage applies whether you see a doctor in the same specialty or a different one.

The key is that the second opinion must be medically reasonable. A doctor examining you for the same condition you already have a diagnosis for will be covered. A second opinion on a diagnosis you do not yet have, or on a condition unrelated to your first visit, may not be. Medicare's rule is straightforward: if the second opinion relates to a condition Medicare would cover treatment for, the opinion itself is covered.

Key Takeaways

  • Medicare Part B covers second opinions at your regular copay or coinsurance, with no referral needed from your first doctor.
  • If surgery is recommended, Medicare covers a second opinion automatically, and a third opinion if the first two disagree.
  • The second opinion must relate to a condition Medicare covers — it cannot be for a new diagnosis unrelated to your first visit.
  • You can see any Medicare-enrolled doctor for a second opinion, including specialists in a different field than your first doctor.
  • Tell the second doctor what your first doctor found and recommended so they have the full picture.

When Medicare requires a second opinion before surgery

Medicare does not require a second opinion before most surgeries, but it does cover one at no extra charge if you want one. The exception is certain elective procedures where a second opinion is strongly encouraged — though "encouraged" is not the same as "required." Your doctor may recommend a second opinion, and Medicare will pay for it.

If you do get a second opinion and the two doctors disagree about whether surgery is necessary, Medicare will cover a third opinion. This rule exists to protect you when the stakes are high. You pay your normal copay or coinsurance for each opinion, but there is no limit on how many you can have if they keep disagreeing.

Bring your test results, imaging, and any written findings from your first doctor to the second opinion visit. This saves time and money — the second doctor will not have to repeat tests that were done recently. If records are not available, the second doctor can request them directly from your first doctor's office.

How to find a doctor for a second opinion

You can see any doctor who accepts Medicare. Use the Medicare provider search tool on Medicare.gov to find doctors in your area, or call 1-800-MEDICARE to ask for names. You can also ask your first doctor for recommendations — many doctors are comfortable with patients seeking second opinions and will suggest colleagues they respect.

You do not have to stay within your health plan's network for a second opinion. If you have a Medicare Advantage plan, check your plan documents to see whether out-of-network doctors are covered. Original Medicare (Part A and Part B) covers any Medicare-enrolled provider, in-network or not.

Some patients prefer to see a doctor at a major medical center or teaching hospital for a second opinion on a serious diagnosis. These doctors are usually Medicare-enrolled and the visit is covered the same way as any other office visit.

What to bring and what to tell the second doctor

Bring your insurance card and photo ID. Bring any test results, lab work, imaging reports, and pathology reports from your first visit. If you have the actual images (X-rays, MRI scans, CT scans), bring those too — they are often more useful than the written report alone.

Tell the second doctor exactly what your first doctor found and what they recommended. Be specific: "My doctor said I have a torn rotator cuff and recommended surgery" is more useful than "My shoulder hurts." The second doctor needs to know the diagnosis, the recommended treatment, and how long the condition has been going on.

If you have already had surgery or started treatment, tell the second doctor that too. A second opinion after treatment has begun is still covered, though it may be less useful than one before you start.

What Medicare does not cover for second opinions

Medicare does not cover a second opinion if it is for a condition that Medicare does not cover treatment for. For example, if you see a doctor for cosmetic surgery and want a second opinion on the cosmetic aspect, that second opinion is not covered — because Medicare does not cover cosmetic surgery in the first place.

Medicare also does not cover second opinions that are purely for reassurance with no medical reason. If you have already had a diagnosis confirmed and treatment completed, and you want another doctor to tell you that you made the right choice, that visit may be coded as a routine follow-up rather than a second opinion, and it will be covered under normal office visit rules.

Telehealth second opinions are covered by Medicare the same way as in-person visits. You pay your copay or coinsurance, and the doctor must be Medicare-enrolled. Some doctors offer second opinion visits by phone or video, which can be faster and cheaper than traveling to an office.

How much a second opinion costs

You pay the same copay or coinsurance you would pay for any other office visit with that doctor. For Original Medicare, that is usually 20% of the Medicare-approved amount after you have met your Part B deductible. For Medicare Advantage plans, your copay depends on your specific plan — check your plan documents or call the plan to find out.

If the second doctor orders new tests or imaging, you pay for those the same way you would pay for any other test. If they use your existing test results instead, there is no extra charge.

Some doctors offer second opinion visits at a flat rate rather than billing Medicare. If a doctor does this, ask whether that rate is less than what Medicare would charge. Some second opinion clinics at major hospitals have set fees that may be lower than a standard office visit.

Second opinions for Medicare Advantage members

If you have a Medicare Advantage plan, your second opinion is covered, but you need to check your plan's rules about in-network versus out-of-network doctors. Most plans cover in-network second opinions at your regular copay. Out-of-network second opinions may have a higher copay or may not be covered at all, depending on your plan.

Some Medicare Advantage plans have a second opinion program built in. Call your plan to ask whether they have a formal second opinion process or a list of doctors who specialize in second opinions. A few plans will even help you arrange the second opinion and send your records automatically.

If you switch from Original Medicare to a Medicare Advantage plan, or vice versa, a second opinion you started under one plan may be covered differently under the other. If you are in the middle of getting a second opinion and your coverage changes, tell the second doctor's office about the change so they can bill correctly.

Frequently Asked Questions

Do I need my first doctor's permission to get a second opinion?

No. You can see another doctor for a second opinion without telling your first doctor. However, the second doctor will need your first doctor's test results and findings, so you will need to sign a release form allowing the second doctor to request those records. Most doctors' offices can do this in one phone call.

Will my first doctor be upset if I get a second opinion?

Most doctors expect patients to seek second opinions on serious diagnoses or before major surgery. If your doctor reacts badly to a second opinion request, that is a sign to consider finding a new doctor. A good doctor wants you to feel confident in your care.

Can I get a second opinion from a doctor outside the United States?

Medicare does not cover care provided outside the United States, with rare exceptions for emergency care in Canada or Mexico. A second opinion from a foreign doctor would not be covered. However, you can pay out of pocket for a foreign second opinion and use that information to guide your care in the United States.

What if the second opinion contradicts the first one?

If two doctors disagree on whether surgery is necessary, Medicare covers a third opinion at no extra cost. After you have three opinions, you and your doctors can discuss the different viewpoints and decide together what makes sense for your situation. You are not obligated to follow any doctor's recommendation.

How long does it take to get a second opinion appointment?

Wait times vary by doctor and location. Some doctors can see you within a week; others may have a wait of several weeks. If you are facing a time-sensitive decision, tell the second doctor's office that when you call to schedule. Many doctors will fit in urgent second opinion requests faster than routine appointments.