How does a Medicare Advantage Plan control the cost of my health care?

In some cases the health plan requires you to have a referral to see a specialist. Many times procedures have to be precertified by your physician before they can be scheduled. The healthcare plan administrators decide whether they precertify the test or treatment recommended by your physician(s). They deny diagnostic studies or medications if they do not consider them medically necessary. They also set the amount of co-pay required when you see your primary physician or your specialist. They determine the amounts of your co-pay for medications.