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How Medicare Handles Second Medical Opinions

Does Medicare cover second medical opinions? The doctor I currently see thinks I need back surgery, but I would like to find out more about other treatment options before I proceed. What can you tell me?

Medicare does pay for second opinions if your current doctor has recommended surgery or some other major diagnostic or therapeutic procedure. Getting a second medical opinion from another doctor is a smart idea. A second opinion may offer you a fresh perspective and additional options for treating your back condition so you can make a more informed decision. Or, if the second doctor agrees with your current doctor’s opinion, it can give you some reassurance moving forward.

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%), and you do not need to obtain an order or referral from your doctor to see another doctor for a second opinion. Medicare will even pay 80% of the costs for a third medical opinion, if the first two differ. Most Medicare Advantage plans cover second opinions too, but you may need to follow certain steps to obtain coverage. For example, some plans will only help pay for a second opinion if you receive a referral from your primary care doctor. Plans also may require you to see doctors in their networks only. If you have a Medicare Advantage plan, you’ll need to call to find your plan’s rules.
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