Does Medicare Cover Second Medical Opinions?

Dear Savvy Senior,
 
Does Medicare cover second medical opinions? The doctor I currently see 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’re 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 cover second opinions too, but you may need to follow certain steps to get it paid for. For example, some plans will only help pay for a second opinion if you have a referral from your primary care doctor, and/or they may require that you can only use a doctor in their network. If you have a Medicare Advantage plan, you’ll need to call it to find out their rules.

Finding Another Doctor

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

Whatever route you choose, it’s best to go with a doctor that’s 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 that 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’ve got a few doctors names, there are a number of free online resources to help you research them like HealthGrades.com and Vitals.com. 

After you find another doctor, before you get a second opinion, you’ll 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. But, if the second doctor wants you to have additional tests performed as a result of your visit, 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. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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