Does Medicare Cover a Second Opinion? (2026)

Quick Answer: What Medicare Covers for Second Opinions in 2026

Yes. Original Medicare Part B covers second opinions before surgery and major diagnostic or therapeutic procedures in 2026. You pay 20% of the Medicare-approved amount after meeting the 2026 Part B deductible of $283. The specialist providing the second opinion must be enrolled in Medicare and must be a different physician than the one who recommended the procedure. If your two opinions conflict, Medicare covers a third opinion under the same cost rules.

What Original Medicare Covers for Second Opinions

Original Medicare Part B covers second opinions as outpatient medical services when a physician recommends that you have surgery or a major diagnostic or therapeutic procedure. Coverage applies to the specialist consultation visit itself, as well as any related tests needed to confirm or support the second opinion. Three key conditions apply: (1) the procedure must be medically necessary, not cosmetic; (2) it cannot be an emergency surgery situation; and (3) the second-opinion specialist must be Medicare-enrolled and different from the referring doctor.

Medicare also covers a third surgical opinion if the first two physicians disagree. The same cost rules apply: 20% coinsurance after the Part B deductible. There is no benefit for a fourth or fifth opinion under Original Medicare. Related diagnostic tests ordered by the second-opinion specialist (such as imaging or biopsies) are covered under their standard Medicare benefit rules, not as part of the second-opinion benefit specifically.

What You Pay Out of Pocket in 2026

Under Original Medicare in 2026, the cost structure for a second opinion visit works the same as any other Part B outpatient specialist visit. The 2026 Part B deductible is $283 per calendar year. Once that deductible is met, you pay 20% of the Medicare-approved amount for the specialist consultation. If your Part B deductible is already satisfied for the year (which is common mid-year), you pay only the 20% coinsurance on the visit.

One important wrinkle: if the specialist does not accept Medicare assignment, that provider can charge up to 15% above the Medicare-approved rate under the limiting charge rule. In that scenario, you would owe 20% coinsurance on the Medicare-approved amount plus the excess charge of up to 15%. To avoid this, confirm the specialist accepts Medicare assignment before the appointment. Use medicare.gov/care-compare to find specialists who accept assignment.

Medicare Advantage and Second Opinions in 2026

Medicare Advantage (Part C) plans are required by federal law to cover at least the same second-opinion benefits as Original Medicare. However, Medicare Advantage plans operate under their own network and prior authorization rules, which can add steps compared to Original Medicare. Most Medicare Advantage HMO plans require a referral from your primary care physician before seeing a specialist for a second opinion. PPO plans generally allow you to see specialists without a referral, but staying in-network costs less.

Medicare Advantage plans may also require prior authorization for the second-opinion visit, particularly when the specialist is outside your plan's network. For cancer diagnoses or complex surgical recommendations, some Medicare Advantage plans have specific second-opinion programs that include centers of excellence at major academic medical centers. Check your plan's Evidence of Coverage document or call the member services number on your card to understand the exact referral and authorization requirements before scheduling.

How Medigap Reduces Your Second Opinion Costs

Medigap (Medicare Supplement Insurance) plans fill the gaps in Original Medicare cost-sharing. For second opinions covered under Part B, the most popular Medigap plans in 2026 (Plan G and Plan N) cover the 20% Part B coinsurance. With Medigap Plan G, after paying the 2026 annual deductible of $283, your out-of-pocket cost for a covered second-opinion visit is typically $0. Plan N may require a small copay of up to $20 for specialist office visits.

When Medicare Does NOT Cover a Second Opinion

Understanding the limits of the second-opinion benefit helps beneficiaries plan accordingly. Original Medicare does not cover second opinions in the following situations: the procedure is cosmetic surgery rather than medically necessary treatment; the surgery is an emergency (immediate surgery does not allow time for a second opinion); you are seeking a second opinion about a general diagnosis without a recommended surgery or major procedure attached; or the specialist you see is not enrolled in Medicare.

A common point of confusion is second opinions for cancer diagnoses. Original Medicare does not cover a stand-alone second opinion for a cancer diagnosis itself. However, Medicare does cover a second opinion if a physician recommends surgery as part of cancer treatment. If you want a second opinion on a cancer diagnosis before surgery is recommended, that visit is billed as a standard Part B specialist consultation and covered as a medically necessary outpatient visit under Part B's general coverage rules.

How to Get a Covered Second Opinion Under Medicare

Getting a covered second opinion under Original Medicare involves five steps. First, obtain the recommendation in writing from your primary doctor specifying the surgery or major procedure being recommended. Second, find a specialist who is Medicare-enrolled, board-certified in the relevant specialty, and different from the recommending physician. Use medicare.gov/care-compare to search by specialty and verify Medicare participation. Third, contact the specialist's office and confirm they accept Medicare assignment, to avoid the 15% excess charge risk. Fourth, bring all relevant records, imaging, and test results so the second-opinion physician has complete information. Fifth, review the specialist's written opinion and compare it against the original recommendation before deciding.

• Ask your doctor for a written referral or recommendation letter specifying the procedure.
• Search for a Medicare-enrolled specialist at medicare.gov/care-compare.
• Confirm the specialist accepts Medicare assignment before the appointment.
• Bring copies of your medical records, imaging, biopsy results, and current medications.
• Request a written second opinion report you can share with your original doctor.
• If opinions conflict, ask for a Medicare-covered third opinion under the same Part B rules.

Alternatives If Medicare Does Not Cover Your Specific Second Opinion

When the specific second opinion you need falls outside what Medicare Part B covers (for example, a non-surgical diagnostic second opinion at an out-of-state academic center, or a second opinion for a cosmetic procedure), several alternatives exist. Many major cancer centers and academic medical systems offer remote second-opinion programs for a fixed fee typically ranging from $300 to $900 per case. Programs include Memorial Sloan Kettering (MSK Direct Second Opinion), Mayo Clinic Second Opinion, Cleveland Clinic MyConsult, and MD Anderson Cancer Center Remote Consultation. These are self-pay programs not billed to Medicare.

For dual-eligible beneficiaries who have both Medicare and Medicaid, Medicaid may cover additional costs that Medicare does not, including any remaining coinsurance after Medicare Part B pays its share. Note that second opinions are a Part B outpatient benefit, not a Medicare Part A inpatient hospital benefit, so they are never billed against your Part A deductible. Medicare Part D does not apply to second-opinion consultation visits. Veterans who also have VA benefits may get second opinions through the VA Choice Program or VA Community Care Network at no extra cost. Contact your State Health Insurance Assistance Program (SHIP) counselor for free guidance specific to your state and situation.

Does Original Medicare cover a second opinion before surgery?

Yes. Original Medicare Part B covers second opinions before medically necessary, non-emergency surgery in 2026. You pay 20% coinsurance after meeting the 2026 Part B annual deductible of $283. The specialist must be Medicare-enrolled and a different physician than the one who recommended the surgery.

Does Medicare Advantage cover second opinions?

Yes. Medicare Advantage plans are required to cover at least the same second-opinion benefits as Original Medicare. However, most HMO plans require a referral from your primary care doctor, and some plans require prior authorization. PPO plans are more flexible. Check your plan's Evidence of Coverage or call member services before scheduling.

Does Medicare cover a third opinion if the first two disagree?

Yes. If your first and second opinions conflict, Original Medicare Part B covers a third opinion under the same cost rules: 20% coinsurance after the 2026 Part B deductible of $283. Medicare does not cover a fourth or fifth opinion. The third-opinion physician must also be Medicare-enrolled and different from the prior two physicians.

What does a Medicare-covered second opinion cost out of pocket in 2026?

Under Original Medicare in 2026, you pay 20% of the Medicare-approved specialist consultation fee after meeting the annual Part B deductible of $283. If your deductible is already met, you pay only the 20% coinsurance. Medigap Plan G or Plan N covers that 20%, potentially reducing your cost to $0 or a small copay. Avoid specialists who do not accept Medicare assignment to prevent excess charges of up to 15% above the approved rate.

Does Medicare cover a second opinion for a cancer diagnosis?

Not directly as a standalone diagnostic second opinion. Original Medicare does not have a separate benefit for a second opinion on a diagnosis. However, if a physician recommends surgery as part of cancer treatment, the second-opinion benefit applies. A specialist consultation to review a cancer diagnosis before surgery is recommended is covered as a standard Part B medically necessary outpatient visit.

Does Medicare cover second opinions for non-surgical procedures?

Yes. The second-opinion benefit extends beyond surgery to major diagnostic and therapeutic procedures. If a physician recommends a significant diagnostic workup or therapeutic intervention, Medicare covers a second opinion under the same Part B rules: 20% coinsurance after the 2026 deductible of $283.

How do I find a Medicare-enrolled specialist for a second opinion?

Use the Medicare Care Compare tool at medicare.gov/care-compare to search for specialists by type, location, and Medicare enrollment status. Filter for providers who accept Medicare assignment to avoid potential excess charges. You can also ask your primary care doctor for a referral to a specific specialist, or contact your State Health Insurance Assistance Program (SHIP) at 1-800-MEDICARE for free personalized guidance.

What if my Medicare Advantage plan denies a second opinion?

If your Medicare Advantage plan denies a second opinion for a medically necessary procedure, you have the right to appeal. Federal law requires Medicare Advantage plans to cover at least the same second-opinion benefits as Original Medicare. Request a written denial with the specific reason. You can file an appeal within 60 days of the denial and request continuation of benefits while the appeal is pending. Contact 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) for help with the appeal process.