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Savvy Senior: Does Medicare cover second opinions?

Updated September 21, 2023 - 7:22 pm

Dear Savvy Senior: Does Medicare cover second medical opinions? My doctor thinks I need a knee replacement, but I would like to get some other treatment options before I proceed. What can you tell me? — Limping Larry

Dear Larry: Getting a second medical opinion from another doctor is a smart idea that may offer you a fresh perspective and additional options for treating your knee so you can make a more informed decision. Or, if the second doctor agrees with your current one, it can give you some reassurance.

Yes, Medicare does pay for second opinions if your current doctor has recommended surgery or some other major diagnostic or therapeutic procedure.

If you are enrolled in original Medicare, 80 percent of the costs for second medical opinions are covered under Part B (you or your Medicare supplemental policy are responsible for the other 20 percent), and you don’t need an order or referral from your doctor to get one. Medicare will even pay 80 percent for a third opinion, if the first two differ.

Most Medicare Advantage plans also cover second opinions, but you may need to follow certain steps to get it paid for. For example, some plans will help pay for a second opinion only if you have a referral from your primary care doctor, and they may require you to use a doctor in their network. If you have a Medicare Advantage plan, you will need to call to find out its rules.

Finding another doctor

To find another doctor for a second opinion you can ask your current doctor for a name or two, ask another doctor you trust for a referral, or find one on your own.

Whatever route you choose, it’s best to go with a doctor who is affiliated with a different practice or hospital than your original doctor. Hospitals and practices can be set in their ways when it comes to treatments and are likely to offer similar advice.

If you choose to find one on your own, use Medicare’s Care Compare tool at Medicare.gov/care-compare. This will let you find doctors by name or medical specialty in your area who accept original Medicare. You can also get this information by calling Medicare at 800-633-4227. Or, if you’re enrolled in a Medicare Advantage plan, call or visit your plan’s website for a list of candidates.

After you have gotten a few doctors’ names, there are a number of free online resources to help you research them, such as HealthGrades.com and Vitals.com.

After you find another doctor, and before you get a second opinion, you will need to have your current doctor’s office send your medical records ahead to the second doctor, or you may have to pick them up and deliver them yourself. That way, you won’t have to repeat the tests you already had. If the second doctor wants you to have additional tests performed as a result of your visit, however, Medicare will help pay for these tests, too.

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).

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org.

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