Quick Answer
Yes - Medicare Part B covers second opinions before surgery and for major diagnoses. The second opinion is treated like any other outpatient doctor visit: Medicare pays 80% of the approved amount after your Part B deductible, and you pay 20% coinsurance. If the second opinion differs from the first, Medicare may also cover a third opinion. Medicare Advantage plans cover second opinions at the same level, though cost-sharing varies.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Medicare Part B (Second Opinion) | Covered | 80% after $283 Part B deductible; you pay 20% coinsurance |
| Medicare Part B (Third Opinion) | Covered if Opinions Differ | Covered when first and second opinions conflict |
| Medicare Advantage (Part C) | Covered | Must cover same services as Original Medicare; cost-sharing varies by plan |
| Medicare Supplement (Medigap) | Varies by Plan | Covers some or all of the 20% coinsurance left by Original Medicare |
Understanding Your Coverage Options
Original Medicare (Part B)
Covered before surgery and for major diagnosesMedicare Part B covers second opinions before surgery and for major diagnoses. A second opinion is treated the same as any other outpatient doctor visit - Medicare pays 80% of the approved amount after your Part B deductible, and you pay 20% coinsurance.
If the second opinion differs from the first, Medicare will also cover a third opinion to help you make an informed decision. You have the right to seek a second opinion from any Medicare-participating specialist, even if they are not in your primary doctor's practice or hospital system.
Getting a second opinion is especially important before elective surgery, when facing a new cancer diagnosis, or when your doctor recommends a major treatment change. Studies show that second opinions change the diagnosis or treatment plan in a significant percentage of cases.
What It Covers
- Second opinion before elective or recommended surgery
- Second opinion for a new cancer diagnosis
- Second opinion for any major diagnosis or treatment decision
- Third opinion when first and second opinions conflict
- Specialist consultation fees
- Review of test results, imaging, and pathology reports
What It Doesn't Cover
- Second opinions from non-Medicare-participating providers
- Opinions sought purely for personal reassurance without a clinical basis
Part B: You pay 20% coinsurance after the $283 annual deductible (2026). A specialist consultation typically costs $150–$400, so your 20% share is $30–$80 after the deductible.
Medicare Advantage (Part C)
Covered - cost-sharing varies by planMedicare Advantage plans are required to cover second opinions at the same level as Original Medicare. However, your cost-sharing depends on your specific plan, and you may need a referral from your primary care physician to see a specialist.
If your plan requires referrals, make sure to get one before scheduling your second opinion appointment. Some Medicare Advantage plans also require prior authorization for specialist visits, so check your plan's requirements in advance.
What It Covers
- Second and third opinions covered by Original Medicare
- Specialist consultations within the plan's network
What It Doesn't Cover
- Out-of-network specialists (unless plan has out-of-network benefits)
- Specialist visits without required referral or prior authorization
Check if You Need a Referral
Some Medicare Advantage plans (especially HMOs) require a referral from your primary care doctor before you can see a specialist for a second opinion. Call your plan before scheduling to avoid unexpected costs.
Medicare Supplement (Medigap)
Covers some or all of Original Medicare's cost-sharingMedicare Supplement (Medigap) plans cover the 20% Part B coinsurance for second opinions, just as they do for any other covered outpatient visit. Medigap Plan G covers the coinsurance in full after you meet the annual Part B deductible.
Unlike Medicare Advantage, Medigap has no provider networks - you can see any Medicare-participating specialist in the country without a referral. This makes it easy to seek a second opinion from a leading specialist at a major medical center.
What It Covers
- Part B coinsurance (20%) for second and third opinions
- Specialist consultation fees after the deductible
What It Doesn't Cover
- Services not covered by Original Medicare
- Non-Medicare-participating specialists
With Medigap Plan G, your only out-of-pocket cost for a second opinion is the $283 Part B deductible (2026). After that, Plan G covers the 20% coinsurance.
When Should You Get a Second Opinion?
Getting a second opinion is a smart step whenever you face a major medical decision. It is not a sign of distrust toward your doctor - it is a recognized part of good medical care. Medicare specifically covers second opinions because they can prevent unnecessary procedures and ensure you receive the most appropriate treatment.
Consider a Second Opinion When:
- Your doctor recommends surgery - especially elective surgery
- You receive a new cancer diagnosis
- Your doctor recommends a major treatment change
- Your diagnosis is rare, complex, or uncertain
- You are not improving with your current treatment
- Your doctor recommends amputation or other irreversible procedure
- You feel uncertain or uncomfortable about the recommended treatment
- Your condition involves multiple specialists with conflicting recommendations
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare. She trains agents on CMS compliance guidelines.