This just happened to me. My Doctor submitted a procedure I have had done before only to receive a denial. It is getting scary when an insurance company, who has never seen me, can overrule my doctor.

Medicare Advantage plans sell themselves hard, making it sound like they are the best deal in the world. Zero monthly premium! Dental and vision care! Even cover part of the cost of hearing aids! Sounds too good to be true - and that's because it is. Having worked for a HMO for many years in the past (and they are similar), I know that offers to cover more for less means that the money to offset these deals has to come from somewhere. And its not the generosity of the insurance companies.

I have traditional Medicare (plan A & B), a plan D for medication, and a plan G for what Medicare A & B don't cover. While there may be more upfront costs, those of us who know we are going to have a lot of medical expenses will not regret it. My expenses include the premium for traditional Medicare (about $165/month, deducted from my Social Security so I never see it) and a deductible of $226 for the year for Plan B (outpatient) in 2023. There is also a deductible for Plan A (inpatient) My plan G this past year was about $120/month. My plan G will pay the Plan A deductible if I'm in the hospital. But the real bonus is that my Plan G pays everything else once I've met the $226 deductible! No copays. Expenses seldom if ever get turned down. (I won't talk about the drug plan as that is a more complex matter.)

I know this sounds confusing if you aren't use to traditional Medicare but once you're signed up, it's quite simple. No forms to fill out, etc. So, if we calculate about how much I paid in premiums for 2023 (not counting medication plan), it comes to roughly $3,500. Add to that the $226 I had to pay for the deductible for the whole year, and that comes to about $3,726.00. This year I had a $35,000 outpatient surgery to implant a device to monitor my heart. I haven't checked to see how much all of my office visits were, my biopsy, my mastectomy, mammogram, ultrasound, MRI of my cervical spine, etc. I haven't checked because I haven't had to pay any of it. Just that $3,726.00 in premiums and deductible. My medication expenses really aren't bad - except for trying to get a migraine preventative. I've given up on that for now, as my copay was going to be $1000/month for something I didn't even know would help me. (I have already tried almost everything so I'm not hopeful.)

But see what great medical coverage I've had this past year? I haven't had that many expenses every year but these premiums are worth it to me. I don't have to worry that I'm not going to be able to get what I need. Beware of Advantage plans!

I have Medicare with supplement and have had no issues with coverage or my doctors being in network.

It has really been ridiculous with insurance companies and dealing with Medicare and Prescriptions. God help us all.🙏

I became disabled @ 57 after the mastectomy and following 2 surgeries that caused severe paresthesia and nerve damage in my chest. I have United health care medicare and the FREE medicare advantage plan through AARP. Have not had many denial issues so far but it has only been 1 year. Just renewed it.