Medicare covers second opinions in most situations, but the rules depend on whether you stay in-network and what type of procedure is involved

Medicare Part B (medical insurance) pays for a second opinion from another doctor if your first doctor recommends surgery or a major procedure. The second doctor must be a Medicare-enrolled provider, and you typically pay the same 20% coinsurance you would for any other Part B service after you meet your deductible. If you have a Medigap or Medicare Advantage plan, your coverage may be better — some plans cover the full cost with no coinsurance.

The catch is that Medicare does not automatically pay for a second opinion just because you want one. The opinion must relate to a specific medical recommendation, usually surgery or a significant intervention. Routine check-ups, lab work, or consultations that are not tied to a treatment decision fall under regular office visits, which Medicare covers at the standard rate.

If you are in a Medicare Advantage plan (Part C), the rules are stricter. Your plan may require you to use in-network doctors, and some plans require pre-authorization before you see a second doctor. Check your plan documents or call the member services number on your card to confirm what your plan covers.

Key Takeaways

  • Medicare Part B covers a second opinion from a Medicare-enrolled doctor when your first doctor recommends surgery or a major procedure.
  • You pay 20% coinsurance after your Part B deductible, the same as you would for the first opinion.
  • Medicare Advantage plans may require the second doctor to be in-network and may need pre-authorization before your visit.
  • A second opinion must relate to a specific treatment recommendation — routine consultations are covered as regular office visits.
  • Medigap plans often cover the 20% coinsurance, so your out-of-pocket cost may be zero.

How Medicare Part B covers second opinions

When your doctor recommends surgery, a major diagnostic test, or another significant procedure, you have the right to get a second opinion before moving forward. Medicare Part B covers this second opinion as a consultation, which means the second doctor examines you, reviews your medical records, and gives you their assessment.

The second doctor bills Medicare directly using the consultation code for your condition. Medicare pays 80% of the approved amount, and you are responsible for 20% coinsurance (after you have met your annual Part B deductible of $240 in 2024). The amount you owe depends on what the second doctor charges and what Medicare considers the approved amount in your area.

You do not need a referral from your first doctor to see a second doctor, and you do not need Medicare's permission in advance. You can straightforward call a Medicare-enrolled doctor's office, explain that you want a second opinion, and schedule an appointment. Bring your medical records, test results, and any imaging from your first doctor so the second doctor has the full picture.

Second opinions in Medicare Advantage plans

Medicare Advantage plans (Part C) operate differently from Original Medicare. Your plan contract determines whether second opinions are covered and under what conditions. Most plans cover second opinions, but they often require the second doctor to be in-network, meaning part of your plan's network of providers.

Some Medicare Advantage plans require pre-authorization — you must call the plan and get approval before you see the second doctor. This is especially common if the second opinion relates to a procedure that the plan wants to review. Check your plan's member handbook or call the number on your insurance card to find out whether pre-authorization is required.

If you see an out-of-network doctor for a second opinion without pre-authorization, your plan may not cover the visit, or it may cover only a small portion. The safest approach is to call your plan first and ask: "I want a second opinion about [procedure]. Do I need pre-authorization, and do I have to use an in-network doctor?"

What counts as a second opinion under Medicare

Medicare covers a second opinion when it relates to a specific medical recommendation — usually surgery, a major diagnostic procedure like a biopsy, or a significant treatment plan. Examples include a second opinion before knee replacement, before cancer treatment, before spinal fusion, or before a major cardiac procedure.

Routine consultations, such as seeing a specialist for ongoing management of a chronic condition or getting a general check-up, are not considered second opinions. These are covered as regular office visits under Medicare Part B, and you pay the standard 20% coinsurance. The difference is whether the visit is tied to a specific treatment decision or is part of ongoing care.

If you are unsure whether your situation qualifies as a second opinion, call the second doctor's office before your appointment and describe what you need. The office staff can tell you how the visit will be coded and what your cost will be. You can also call Medicare at 1-800-MEDICARE to ask whether a specific situation qualifies.

Medigap and second opinion coverage

If you have a Medigap (supplemental insurance) plan, your coverage for second opinions may be better than Original Medicare alone. Many Medigap plans cover the 20% coinsurance that Medicare does not pay, which means you may have zero out-of-pocket cost for the second opinion.

The exact coverage depends on which Medigap plan you have (Plan A, B, C, D, and so on). Plans G, N, and F tend to have the most comprehensive coverage, but even basic plans often cover the Part B coinsurance. Check your Medigap plan documents or call your supplemental insurance company to confirm what they cover for consultations and second opinions.

If you do not have Medigap and are concerned about the 20% cost, ask the second doctor's office for an estimate before your visit. They can tell you what Medicare's approved amount is in your area and what you will owe.

How to find a doctor for a second opinion

Start by asking your first doctor for a referral and your medical records. Many doctors are comfortable with second opinions and will provide records without hesitation. If your doctor seems reluctant, you have the right to request your records anyway — they must provide them within 30 days.

To find a Medicare-enrolled doctor, use the Medicare Provider Search tool at Medicare.gov. Enter your location and specialty (for example, "orthopedic surgeon" or "oncologist"), and the tool will show you doctors who accept Medicare. You can also ask your primary care doctor for names of specialists in your area, or call your local hospital and ask for a referral.

When you call to schedule, tell the office that you are seeking a second opinion. This helps them set aside enough time and ensures your medical records are ready before your appointment. Bring copies of all relevant tests, imaging, and your first doctor's notes to the appointment.

What to expect during a second opinion visit

The second doctor will review your medical history, examine you if needed, and look at any tests or imaging from your first doctor. They will then give you their assessment: whether they agree with the first doctor's recommendation, suggest a different approach, or recommend no treatment at all.

The second doctor will send a report to you and, with your permission, to your first doctor. This report becomes part of your medical record and can help you and your doctors make the best decision about your care. You are not obligated to follow either doctor's recommendation — the second opinion is meant to give you information so you can decide what is right for you.

If the two doctors disagree significantly, you may want a third opinion, which Medicare will also cover under the same rules. Some people find that a third opinion helps break a tie or gives them more confidence in their decision.

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 or getting their permission. However, it is helpful to ask your first doctor for your medical records and test results so the second doctor has complete information. If your doctor refuses to provide records, you can request them directly — they must comply within 30 days.

Will getting a second opinion delay my treatment?

A second opinion typically takes one to two weeks to arrange and complete. If your condition is urgent or life-threatening, discuss timing with your doctor. In emergency situations, you may need to proceed with treatment before a second opinion is possible, but you can still seek a second opinion afterward if you wish.

What if the second doctor charges more than Medicare's approved amount?

If the second doctor is a Medicare-enrolled provider, they must accept Medicare's approved amount as payment in full. You pay only your 20% coinsurance based on that approved amount. If a doctor does not accept Medicare assignment, ask before your visit so you understand what you will owe.

Can I get a second opinion from a doctor outside my state?

Yes, as long as the doctor is Medicare-enrolled. You can travel to see a specialist in another state, or some specialists offer telehealth consultations. Medicare covers telehealth second opinions the same way it covers in-person visits. Check with the doctor's office about whether they offer virtual consultations.

Does Medicare cover a second opinion if I am thinking about refusing treatment?

Yes. If your doctor recommends treatment and you are considering refusing it, a second opinion is covered. The second doctor can confirm whether the treatment is necessary, discuss alternatives, or support your decision to decline treatment. This can be especially helpful if you want to make sure you are making an informed choice.