Medicare Covers Second Opinions in Certain Cases – newsletter 11-6-23

In Jim Miller’s “Savvy Senior” column, a questioner asked if Medicare will cover second opinions. The answer is a qualified “yes.” The official Medicare website says Medicare Part B covers a second opinion “for medically necessary surgery that isn’t an emergency.” Miller adds Medicare might also cover second opinions for “other major diagnostic or therapeutic procedures” apart from surgery. And Medicare will also help pay for a third surgical opinion if the first and second opinions differ. With original Medicare, you do not need a referral to get the second opinion, but if you are in a Medicare Advantage (MA) plan you might need to follow steps the plan outlines. It would be best to confirm this ahead of time with your plan. Remember too that there may be some costs for second opinions, such as the 20% coinsurance with original Medicare (which a Medicare Supplement may cover if you have one) or specified costs in a MA plan. Miller recommends that if you should choose to get a second opinion, it would be prudent to check with a doctor not affiliated with the practice where you got the first opinion, since other doctors there are likely to offer similar advice. He suggests searching physician credentials and ratings on sites such as https://www.healthgrades.com/ or https://www.vitals.com/. For more on the subject, check out the Medicare publication on second opinions at https://www.medicare.gov/publications by entering number 02173 in the Keyword or Product number box.

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