Key Takeaways
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Medicare Advantage plans may look appealing in ranked lists, but those rankings often hide trade-offs like limited provider networks, restricted service areas, or prior authorization hurdles.
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The Centers for Medicare & Medicaid Services (CMS) star ratings offer a quality snapshot, but choosing a plan based only on stars could mean missing critical coverage details that affect your care.
Understanding What “Best” Really Means
Every fall, you’re likely bombarded with rankings that promise to show you the “best” Medicare Advantage plans. These lists might seem helpful at first glance, especially during Medicare Open Enrollment from October 15 through December 7. But the truth is, what’s best on paper may not be best for you.
You may wonder: What criteria are used to declare these plans “best”? Are these lists objective? And most importantly, how should you approach them when deciding your own coverage? Let’s explore what goes into these rankings and what you should really pay attention to in 2025.
What Are Medicare Advantage Plans?
Medicare Advantage (Part C) plans are alternatives to Original Medicare. Offered by private insurers, these plans bundle Part A (hospital) and Part B (medical) coverage, and often include Part D (prescription drug coverage) and extra benefits like dental, vision, or hearing services.
In exchange for these bundled services, you agree to receive care through a defined network of providers, which could be an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). Most Medicare Advantage plans also come with annual out-of-pocket maximums, providing financial protection not offered by Original Medicare alone.
Why Lists of the “Best Plans” Can Be Misleading
While online lists can be useful as a starting point, they rarely tell the full story. Here’s why:
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Ranking criteria vary: Some lists emphasize star ratings, others focus on affordability or extra benefits. Few balance all factors that impact your personal experience.
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What works for one person may not work for another: A plan that receives high ratings for service may have a limited provider network in your area.
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They may ignore your unique health needs: Chronic conditions, prescription medications, and doctor preferences all influence which plan truly meets your needs.
What the CMS Star Ratings Actually Tell You
Each year, CMS rates Medicare Advantage plans from 1 to 5 stars. These ratings are updated annually and reflect:
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Member experience and satisfaction
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Management of chronic conditions
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Preventive services
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Customer service
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Drug safety and pricing accuracy
In 2025, the latest ratings incorporate more weight on patient outcomes and access to timely care. A 5-star plan generally indicates excellent performance, but it doesn’t guarantee that the plan will suit your needs.
Plans rated 5 stars may offer a Special Enrollment Period, allowing you to switch once to a 5-star plan outside the usual enrollment windows. However, switching solely for a higher rating without understanding how the plan fits your situation can backfire.
Key Plan Features That Rankings May Overlook
Even highly rated plans can fall short in important areas. Be sure to examine:
Provider Networks
Many plans require you to see in-network doctors. Even if a plan has strong ratings, its network in your county might exclude your primary care physician or specialists. Always verify if your providers participate in the plan you’re considering.
Referral and Authorization Requirements
Some plans require prior authorizations for procedures or referrals to see specialists. This can delay your care. A high CMS rating doesn’t necessarily mean fewer hurdles.
Service Area Limitations
Each Medicare Advantage plan operates in a specific geographic region. You may see a top-rated plan in national rankings that isn’t available where you live. Or worse, a plan may cover only a limited portion of the services in your ZIP code.
Prescription Drug Coverage
If you rely on specific medications, check the plan’s formulary (covered drug list). Ratings don’t tell you whether your exact drug is covered, or at what cost tier. You should also review if step therapy or quantity limits apply.
Out-of-Pocket Costs
Medicare Advantage plans set their own copayments, coinsurance, and deductibles. You may see a plan rated highly for overall satisfaction but find it has high costs for hospital stays or specialty care. In 2025, the average out-of-pocket maximum across plans is expected to remain below $8,000, but variation remains high.
What to Prioritize When Evaluating Plans
Don’t rely solely on rankings. Instead, take a holistic approach by considering:
1. Your Preferred Providers
Do you have doctors or clinics you want to keep? Confirm they’re in the plan’s network. If not, you may face out-of-network charges or need to switch providers.
2. Coverage for Your Medications
Use the plan’s drug search tools to look up each prescription you take. Check tier levels, monthly costs, and whether prior authorization is required.
3. Anticipated Medical Needs
If you expect surgeries, specialty treatment, or ongoing physical therapy, compare plans based on out-of-pocket costs for those services. Rankings won’t show this level of detail.
4. Convenience and Accessibility
Do you want telehealth options? Is the plan’s customer service responsive? Are local pharmacies included? These quality-of-life factors often matter more than the number of stars.
5. Enrollment Flexibility
Plans with 5 stars allow a one-time switch anytime during the year. That may be useful if your situation changes and you need to enroll outside standard enrollment windows.
Why You Shouldn’t Just Pick the Highest-Rated Plan
A plan with a 5-star rating might still fail to meet your priorities. For example:
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It may not include your local hospital.
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It might have high coinsurance for specialists.
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It could impose prior authorization on key services.
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It may not cover your essential medications.
CMS ratings are an important tool, but they aren’t designed to reflect your unique care situation. What’s highly rated nationally may not be the right choice locally.
How to Compare Plans the Right Way
When reviewing options, start with these steps:
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Visit the Medicare Plan Finder to compare available plans in your area.
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Enter your medications and preferred pharmacies to view actual drug costs.
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Review network directories to confirm your providers are included.
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Use plan benefit summaries to compare copayments, deductibles, and annual limits.
You should also revisit your plan each year. Even if your current plan worked well in 2024, changes to coverage, cost, or provider networks in 2025 could impact your experience.
Common Mistakes to Avoid
To make a sound choice, avoid these pitfalls:
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Choosing based only on premiums: A low monthly cost might come with high deductibles or fewer providers.
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Overlooking network changes: Networks can shrink or change year to year. Confirm provider participation annually.
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Not checking the formulary: Drug coverage changes frequently. Don’t assume the same medication will be covered.
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Relying on third-party lists: Articles that list “best plans” may use metrics that don’t reflect your priorities.
When to Enroll or Make Changes
Understanding the Medicare timeline is just as important as picking the right plan:
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Initial Enrollment Period: Starts 3 months before your 65th birthday, includes your birth month, and ends 3 months after.
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Open Enrollment Period: October 15 to December 7 every year. This is your chance to switch or join a Medicare Advantage plan for the upcoming year.
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Medicare Advantage Open Enrollment: January 1 to March 31. If already enrolled in a Medicare Advantage plan, you can switch to a different one or go back to Original Medicare.
In some cases, you may qualify for a Special Enrollment Period due to a life event like moving, losing employer coverage, or qualifying for Medicaid.
Making Informed Medicare Decisions Starts with You
By all means, consider CMS ratings. But don’t stop there. Align the plan details with your actual care needs and preferences. Look past marketing claims, star scores, and “best of” lists that don’t account for your health goals, medication usage, or location.
Speak with a licensed agent listed on this website if you’d like help comparing your options for 2025. They can walk you through benefits, restrictions, and potential cost-saving opportunities based on your personal situation.
