Why You Might Be Comparing the Worst Medicare Advantage Plans Without Realizing It During Open Enrollment

Key Takeaways

• During the 2025 Open Enrollment period, many Medicare beneficiaries are unknowingly comparing low-rated Medicare Advantage plans, mistaking flashy marketing for quality care.

• Understanding plan star ratings, hidden cost structures, and network limitations is essential to avoid enrolling in one of the worst Medicare Advantage plans.

The Illusion of Choice During Open Enrollment

Every year from October 15 to December 7, you are presented with what seems like a wide array of Medicare Advantage plan options. On the surface, this annual Open Enrollment period feels empowering. You can switch, drop, or enroll in a plan that better suits your needs. But beneath the surface, some of the worst Medicare Advantage plans are quietly competing for your attention using aggressive marketing tactics and incomplete information.

These plans may look good in brochures or television ads, but their real costs and limitations only become obvious when you try to access the care you need.

Star Ratings: A Warning Sign You May Miss

One of the clearest indicators of a poor-quality Medicare Advantage plan is its CMS star rating. The Centers for Medicare & Medicaid Services (CMS) assigns star ratings from 1 to 5 based on performance in areas like customer satisfaction, management of chronic conditions, member experience, and preventive care.

• Plans with fewer than 3 stars are considered below average.

• Plans rated 2.5 stars or less often struggle with provider access, customer service, and care coordination.

If you see a plan with a 2-star or 2.5-star rating, that should raise immediate concerns. These plans have failed to meet basic quality expectations year after year.

Yet during Open Enrollment, many of these low-rated plans still appear in comparison tools and are marketed alongside higher-rated plans, often without a clear warning.

Misleading Marketing Is a Common Trap

The worst Medicare Advantage plans use marketing strategies that rely heavily on emotional appeal. Ads may promise extra benefits, convenience, or ease of use without revealing how these perks are funded or what trade-offs they involve.

Common tactics include:

• Overemphasizing routine benefits (e.g., vision or dental) while downplaying medical coverage limits

• Glossing over the plan’s out-of-pocket maximums, which can be as high as $9,350 in 2025 for in-network care

• Failing to disclose plan restrictions such as prior authorizations or limited networks

During Open Enrollment, you may find yourself comparing several plans that all claim to offer “comprehensive” coverage. But if they share features like high out-of-pocket limits, low star ratings, or poor provider access, you could be evaluating options that are all among the worst in the marketplace.

Limited Networks Can Disrupt Your Care

One of the most frustrating surprises with poorly rated Medicare Advantage plans is the restricted provider network. You may not realize until after enrollment that your preferred doctors, hospitals, or specialists are not in-network.

Some plans:

• Have limited contracts with local or specialized providers

• Require referrals for specialist visits

• Use narrow networks that change from year to year

In 2025, plan networks continue to shift. If a provider you saw in 2024 is no longer covered, you may be forced to change physicians or pay the full cost of care. This can be especially difficult during treatment for chronic conditions.

Prior Authorizations Can Delay or Deny Care

Another hidden cost of many poorly rated plans is the administrative burden of prior authorizations. This is when your plan requires you to get approval before certain services will be covered.

Common examples include:

• MRIs and CT scans

• Home health care

• Physical therapy

• Surgeries and some prescription drugs

Low-quality Medicare Advantage plans often rely on prior authorizations to control costs. But this also leads to delays in care and a higher likelihood of denial. In urgent medical situations, that delay can result in serious consequences.

The “All-in-One” Pitch Can Be Misleading

Many Medicare Advantage plans market themselves as “all-in-one” solutions that combine hospital, medical, and drug coverage. This sounds attractive, but in low-quality plans, the simplicity is often a mirage.

You might be comparing:

• Plans with limited or missing Part D drug formularies

• Plans that exclude specialty medications or require high copays

• Plans that impose tiered drug pricing or excessive step therapy requirements

In 2025, prescription costs under Part D are capped at $2,000 annually, but if a plan does not manage this well or excludes high-cost drugs from its formulary, your costs could still be significant.

Low Premiums Distract From High Out-of-Pocket Costs

During plan comparisons, you may be drawn to plans with low monthly premiums. However, the worst plans often compensate with:

• High annual deductibles

• Copayments for every visit or test

• Higher coinsurance percentages

• Elevated out-of-pocket maximums

The 2025 maximum out-of-pocket limit for in-network services is $9,350, but many poor-quality plans offer no meaningful protection below that threshold. The result is that you pay more over the course of the year despite saving on monthly costs.

Extra Benefits Don’t Equal Better Coverage

Medicare Advantage plans can include additional benefits like dental, hearing, or transportation. But in the worst plans, these benefits may:

• Be limited to a narrow list of providers

• Offer only minimal annual coverage (e.g., one cleaning or hearing aid every 5 years)

• Require you to use third-party vendors that are difficult to access

Extra benefits should never be the deciding factor in plan selection. They are often the most heavily marketed feature while the medical coverage quality is overlooked.

Star Ratings Aren’t Always Highlighted in Plan Materials

During Open Enrollment, many beneficiaries rely on the Medicare Plan Finder or marketing mailers. Unfortunately, not all plan marketing materials emphasize CMS star ratings.

You may be comparing:

• Several low-rated plans without realizing they all received 2.5 stars or less

• Plans with a history of sanctions or corrective action plans

If you don’t actively look for the CMS star rating and read the annual “Summary of Benefits” or “Evidence of Coverage” documents, you may choose a plan based on surface-level features rather than verified performance.

CMS Flagged and Sanctioned Plans Still Get Listed

While CMS can flag poor performance, it doesn’t always remove low-rated plans from the marketplace. Some plans may even be under “corrective action” but still accept enrollments.

Signs of concern include:

• Plans with repeated performance issues over 3 or more years

• Plans that fail to improve even after CMS intervention

• Plans that are consistently ranked in the bottom quartile nationally

Comparing such plans alongside stable, highly-rated ones without understanding the implications puts you at risk of picking the wrong coverage.

What to Do Before You Compare Plans Again

It’s easy to be swayed by advertising or quick comparisons during the rush of Open Enrollment. But with careful review, you can avoid the pitfalls that lead many into subpar Medicare Advantage coverage.

Take the following steps:

• Check CMS Star Ratings: Look for plans with at least 4 stars for better quality and service.

• Read the Fine Print: Review plan documents to understand deductibles, copays, and prior authorization policies.

• Verify Provider Networks: Confirm that your preferred doctors and hospitals are in-network for 2025.

• Compare Drug Coverage: Make sure your prescriptions are covered and affordable under the plan’s Part D formulary.

• Evaluate the True Cost: Don’t be fooled by low premiums. Look at total potential out-of-pocket costs.

How Poor Comparisons Can Impact Your Health and Budget

Choosing one of the worst Medicare Advantage plans doesn’t just affect your paperwork or wallet. It can directly impact your access to care, delay treatments, limit specialist referrals, and leave you unprotected in emergencies.

In 2025, healthcare inflation and provider network shifts make these decisions more critical than ever. If you make a misstep during Open Enrollment, you may be locked into your plan for an entire year unless you qualify for a Special Enrollment Period.

Better Enrollment Starts With Better Information

You can avoid comparing the worst Medicare Advantage plans if you approach Open Enrollment with a clear set of priorities: quality, access, coverage, and transparency. Relying solely on ads or surface-level features can leave you with a plan that doesn’t protect your health or finances when it matters most.

To get help making a confident choice, connect with a licensed agent listed on this website. They can guide you through the available options and ensure you’re not stuck comparing bad plans that only look good on the surface.