Getting a Second Opinion

Before Surgery

What is a second opinion?

A second opinion is when a doctor other than your regular doctor gives

his or her view about your health problem and how it should be

treated. Getting a second opinion can help you make a more informed

decision about your care. 

Medicare Part B (Medical Insurance) helps pay for a second opinion

before surgery. When your doctor says you have a health problem that

needs surgery, you have the right to the following: 

• Know and understand your treatment choices. 

• Have another doctor look at those choices with you (second opinion). 

• Participate in treatment decisions by making your wishes known. 

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CENTERS FOR MEDICARE & MEDICAID SERVICES
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When to get a second opinion 

If your doctor says you need surgery to diagnose or treat a health problem

that isn’t an emergency, you should consider getting a second opinion. It’s up

to you to decide when and if you will have surgery. You might also want a

second opinion if your doctor tells you that you should have certain kinds of

major non-surgical procedures. 

Medicare doesn’t pay for surgeries or procedures that aren’t medically

necessary, such as cosmetic surgery. This means that Medicare won’t pay for

second opinions for surgeries or procedures that aren’t medically necessary. 

Don’t wait for a second opinion if you need emergency surgery. Some types

of emergencies may require surgery right away, such as the following: 

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Acute appendicitis 

Blood clot or aneurysm 

Accidental injuries 

Finding a doctor for a second opinion 

Make sure the doctor giving the second opinion accepts Medicare. To find a

doctor for a second opinion, you can do the following: 

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Visit www.medicare.gov and select “Resource Locator” to find doctors who

accept Medicare. 

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call

1-877-486-2048. Ask for information about doctors who accept Medicare. 

Ask your doctor for the name of another doctor to see for a second

opinion. Don’t hesitate to ask; most doctors want you to get a second

opinion. You can also ask another doctor you trust to recommend a doctor. 

Ask your local medical society for the names of doctors who treat your

illness or injury. Your local library can help you find your local medical

society. 
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What to do when you get a second opinion 

Before you visit the second doctor, you should do the following: 

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Ask your doctor to send your medical records to the doctor giving the

second opinion. That way, you may not have to repeat the tests you

already had. 

Call the second doctor’s office and make sure they have your records. 

Write down a list of questions to take with you to the appointment. 

Ask a friend or loved one to go to the appointment with you. 

During the visit with the second doctor, you should do the following: 

Tell the doctor what surgery you are considering. 

Tell the doctor what tests you already had. 

Ask the questions you have on your list and encourage your friend or

loved one to ask any questions that he or she may have. 

Note: The second doctor may ask you to have additional tests performed

as a result of the visit. Medicare will help pay for these tests just as it helps

pay for other services that are medically necessary. 

What if the first and second opinions are

different?

If the second doctor doesn’t agree with the first, you may feel confused

about what to do. In that case, you may want to do the following: 

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Talk more about your condition with your first doctor. 

Talk to a third doctor. Medicare helps pay for a third opinion. 

Getting a second opinion doesn’t mean you have to change doctors. You

decide which doctor you want to do your surgery. 
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How much does Medicare pay for a second

opinion before surgery?

Medicare Part B helps pay for a second opinion and related tests just as it

helps pay for other services that are medically necessary. 

If you have Medicare Part B and are in Original Medicare, here is what you

and Medicare pay: 

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Medicare pays 80% of the Medicare-approved amount for a second opinion. 

Your share is usually 20% of the Medicare-approved amount after you pay

your yearly Part B deductible. The Part B deductible may increase each year. 

If the second opinion doesn’t agree with the first opinion, Medicare pays

80% of the Medicare-approved amount for a third opinion. 

Do Medicare Advantage Plans cover second

opinions?

If you are in a Medicare Advantage Plan (like an HMO or PPO), you have

the right to get a second opinion. If the first two opinions are different, your

plan will help pay for a third opinion. 

Even though you have the right to get a second opinion, you should keep the

following things in mind if you are in a Medicare Advantage Plan: 

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Some plans will only help pay for a second opinion if you have a referral (a

written OK) from your primary care doctor. 

Some plans will only help pay for a second opinion from a doctor who is in

your plan’s provider network. 

If you are in a Medicare Advantage Plan, call your plan for more information. 

Note: If you have Medicaid, it might also pay for second surgical

opinions. To find out, call your State Medical Assistance (Medicaid)

office. You can get the phone number by doing the following: 

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call

1-877-486-2048. 

Visit www.medicare.gov and select “Help and Support.” 

CMS Product No. 02173 

Revised June 2010