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Sometimes going to one doctor for a checkup, medical advice, or a recommendation is not enough. This is especially true if you are trying to make an informed decision about taking a new medication, medical procedure or new diagnosis of a health condition.
It is possible that the first doctor you go to will not recommend the best solution for you. Or, in some cases, may even be wrong. And when your health is on the line, you want to be sure you have the best, more accurate info.
So, in some cases, you may want to visit another doctor to get their opinions and recommendations with regard to your condition. These are known as second or third opinions.
If you are in a position like this, you may be wondering, “Does Medicare cover second opinions?”
In this article, we answer the question in clear, plain English. You will also find the average costs of getting a second opinion.
Does Medicare Cover Second Opinions?
The short answer is yes. Medicare will cover the cost of second opinions. But not 100% of the time.
As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your second opinion. Let’s take a look at what these conditions are so you know what to expect.
Original Medicare Coverage of Second Opinions
Original Medicare (Medicare Part A and Part B) does provide coverage for second opinions.
Coverage for second opinions is provided by Medicare Part B if it takes place in an outpatient setting.
If you want to see another healthcare provider for their recommendations for the treatment of your medical condition, Medicare Part B will provide coverage for it. Medicare Part B will also provide coverage for a third opinion from another healthcare provider.
When Medicare Part B Does Not Cover Second Opinions
However, Medicare Part B does not always cover second and third opinions.
Medicare Part B will not provide coverage for a second opinion when the surgery is not covered by Original Medicare.
This plan does not provide coverage for second opinions for the following services:
- Alternative medicine
- Cosmetic surgery
- Non medically necessary dental care
- Hearing aids
- Custodial care
- Long-term care
- Non-emergency transportation
- Routine foot care
- Non medically necessary vision care
Once approved, Medicare Part B covers 80 percent of the costs of second opinions. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Second Opinions
Medicare Advantage plans (Medicare Part C) also provide coverage for second opinions. These plans have to cover everything Original Medicare covers. They offer some additional benefits as well that Part A or B does not cover.
However, exactly what a Part C plan covers and how much the out-of-pocket costs are will vary depending on the plan you have.
How Much Do Second Opinions Cost?
The cost of getting a second opinion varies based on a number of factors. These include the type of doctor you see, how complicated your case is and more.
As an example, getting a virtual second opinion costs $1,850 on average at the world renowned, Cleveland Clinic. What is included are the following:
- A consultation with a nurse care manager
- Collection of medical records from healthcare providers and hospitals
- Reinterpretation of previous imaging scans and lab tests
- An expert review of your case by a specialist
- Video consultation and written report from the specialist after the review.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover Skin Cancer?