Does job-based or Marketplace insurance cover second opinion?

Usually covered as a specialist visit. Many plans cover second opinions and some require one before certain surgeries. Use an in-network specialist and check referral rules. Cost: Expect your deductible, then a copay or coinsurance. Ask the plan for a negotiated estimate before care.

Does Original Medicare cover second opinion?

Yes, Medicare covers second (and sometimes third) surgical opinions. Part B covers a second opinion before non-emergency surgery. Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.

Does Medicare Advantage cover second opinion?

Yes, Medicare covers second (and sometimes third) surgical opinions. Part B covers a second opinion before non-emergency surgery. Medicare Advantage plans must cover this too, but set their own copays and often require in-network providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.

Does Medicaid cover second opinion?

Usually covered when medically necessary. Managed-care plans may require a referral.

Is second opinion covered by insurance?

Seeing another doctor before surgery or major treatment. Here’s how each kind of plan usually handles it.

Ask a specific question Plan a visit: cost and doctors Check it against my plan

Employer or MarketplaceUsually covered
Usually covered as a specialist visit.
More details
Many plans cover second opinions and some require one before certain surgeries. Use an specialist and check rules.
Cost: Expect your deductible, then a copay or coinsurance. Ask the plan for a negotiated estimate before care.
Original MedicareUsually covered
Yes, Medicare covers second (and sometimes third) surgical opinions.
More details
covers a second opinion before non-emergency surgery.
Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
Medicare AdvantageUsually covered
Yes, Medicare covers second (and sometimes third) surgical opinions.
More details
covers a second opinion before non-emergency surgery. plans must cover this too, but set their own copays and often require in-network providers and prior authorization.
Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidCovered with conditions
Usually covered when medically necessary.
More details
Managed-care plans may require a .

Plan type	How it’s usually covered
Employer or MarketplaceUsually covered	Usually covered as a specialist visit. Many plans cover second opinions and some require one before certain surgeries. Use an specialist and check rules. Cost: Expect your deductible, then a copay or coinsurance. Ask the plan for a negotiated estimate before care.
Original MedicareUsually covered	Yes, Medicare covers second (and sometimes third) surgical opinions. covers a second opinion before non-emergency surgery. Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
Medicare AdvantageUsually covered	Yes, Medicare covers second (and sometimes third) surgical opinions. covers a second opinion before non-emergency surgery. plans must cover this too, but set their own copays and often require in-network providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidCovered with conditions	Usually covered when medically necessary. Managed-care plans may require a .

What usually has to be true

Referral rules apply in HMO plans.

Good to know

Some employers offer free expert second-opinion services as a separate benefit.

Specialist visit · Dermatologists, cardiologists, GI doctors, orthopedists, and other specialists.
Surgery · Inpatient or same-day surgical procedures.

Sources

Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.

1
What Marketplace plans cover
HealthCare.gov
Marketplace plans cover outpatient care, hospitalization, mental health care, prescription drugs, rehabilitation, laboratory services, preventive services, and other essential benefit categories.
2
Second surgical opinions
Medicare.gov
Part B covers a second opinion before non-emergency surgery and, in some cases, a third opinion.
3
Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
4
Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.

General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.

Is second opinion covered by insurance?

What usually has to be true

Good to know

Related

Sources