You may be nervous about whether Medicare will cover a second opinion if you wish to confirm whether a medical treatment or surgery is right for you. Given the cost of doctor visits today, the prospect of an out-of-pocket expense for a second opinion is understandably concerning.
Under Medicare Part B…
Medicare Part B will help pay for a second opinion if a doctor recommends that you pursue a medically necessary surgery or another major procedure. In fact, the Department of Health and Human Services recommends that a person get a second opinion when their doctor tells them surgery is needed to diagnose or treat a nonemergency but medically necessary health issue.
However, “medically necessary” is a significant component of coverage. Medicare won’t pay for second opinions for surgeries or procedures that aren’t medically necessary. These include cosmetic procedures, alternative medicine, most dental care, non-medical services, some vision, and other excluded services.
Remember, before seeking any second opinion on a procedure, confirm that the doctor accepts Medicare. Third opinions may also be covered if the first two opinions are different from each other.
If the second doctor orders additional tests, as long as they are medically necessary, Medicare will also help pay for these expenses. The payment structure will be the same as for the first opinion. After you meet your yearly Part B deductible, Medicare pays 80 percent of the approved amount, and you pay 20 percent, plus any copay.
What About Medicare Advantage?
You should also be able to get coverage for a second opinion if you have a Medicare Advantage Plan. Just remember that some Medicare Advantage Plans will only cover a second or third opinion if you have a referral from your primary care doctor and the second doctor is in-network.
Readers should also remember that just because Medicare may cover a second or third opinion, coverage of the therapy, surgery, or procedure is not guaranteed. Find more answers to your Medicare questions by calling Kristen Matthews, Certified Elder Law Attorney at 484-874-2987.