Best Medicare Advantage Plans Could Work for You—If You Know What to Look For

Key Takeaways

• The best Medicare Advantage plans in 2025 often include extra benefits, but evaluating CMS ratings, out-of-pocket costs, and provider networks is essential before enrolling.

• A plan that works for one person might not meet your health or financial needs. Understand how each plan’s structure affects coverage, access, and long-term affordability.

What Makes a Medicare Advantage Plan “The Best”?

You’ve likely seen a flood of advertisements claiming to offer the “best” Medicare Advantage plan. But in reality, what qualifies as the best plan depends on your unique healthcare needs, financial situation, and preferences.

In 2025, the Centers for Medicare & Medicaid Services (CMS) continues to evaluate Medicare Advantage (Part C) plans using a 5-star quality rating system. This rating assesses:

• Preventive care services

• Chronic condition management

• Member experience and satisfaction

• Plan responsiveness

• Customer service

Plans with 4 stars or higher are generally seen as higher quality. But a top-rated plan may still fall short for you if it excludes your doctors or charges more for your medications.

Standard Features to Expect in 2025 Medicare Advantage Plans

While plans vary widely, most include the following features in 2025:

• All-in-One Coverage: Combines Medicare Part A (hospital), Part B (medical), and usually Part D (prescription drugs).

• Out-of-Pocket Limits: A yearly maximum to protect you from catastrophic costs. In 2025, the maximum in-network limit is $9,350.

• Extra Benefits: These may include dental, vision, hearing, fitness memberships, or telehealth services.

• Managed Care Networks: Most plans operate as HMOs or PPOs, each with different rules about provider access and referrals.

You may find that a high-rated plan with broad coverage and low copayments on paper still limits access due to narrow provider networks or regional availability.

How the CMS Star Ratings Help You Compare Plans

CMS updates its ratings annually based on over 40 performance measures. These include how often plan members receive recommended screenings, manage chronic conditions, and rate their plan.

• 5-Star Plans: Highest quality, eligible for a Special Enrollment Period.

• 4-Star Plans: Above average performance, widely considered good options.

• 3-Star or Lower: May have persistent issues with service or coverage. Often best avoided unless no better option is available in your area.

However, don’t choose based on star ratings alone. A 5-star plan in a different county might not be available in your ZIP code or might restrict your access to local specialists.

Questions You Should Ask Before Enrolling

Choosing the best Medicare Advantage plan in 2025 starts by asking the right questions:

• Are your doctors and preferred hospitals in-network?

• Are your prescriptions covered under the plan’s formulary?

• How much are the copayments and coinsurance for services you frequently use?

• What’s the in-network and out-of-network maximum out-of-pocket cost?

• Is prior authorization required for procedures or medications?

These questions help you look beyond marketing to what actually matters for your care.

Hidden Trade-Offs You Might Miss

Medicare Advantage plans can offer added value, but that value can come with trade-offs:

• Referrals and Prior Authorization: Many plans require referrals to see specialists and pre-approval for surgeries or even diagnostic imaging. This may delay care.

• Out-of-Network Limitations: PPOs may allow out-of-network care but at a higher cost. HMOs usually won’t cover it at all.

• Regional Variation: Some benefits and costs vary even within the same plan based on your location.

• Drug Tiers and Restrictions: Some plans restrict expensive medications through step therapy or require higher cost-sharing.

The best plan for someone else may not provide the access or coverage you expect. Always review the plan details, including the Evidence of Coverage (EOC), before enrolling.

Timing Matters: When to Enroll or Switch

You have specific windows to enroll in or change Medicare Advantage plans:

• Initial Enrollment Period (IEP): 7-month window around your 65th birthday.

• Annual Enrollment Period (AEP): October 15 to December 7. Changes take effect January 1.

• Medicare Advantage Open Enrollment Period (MA-OEP): January 1 to March 31. You can switch to a different Medicare Advantage plan or return to Original Medicare.

• Special Enrollment Periods (SEP): Triggered by qualifying events such as moving or losing coverage. Some 5-star plans may allow enrollment anytime.

Knowing when you can enroll or switch helps ensure you don’t get locked into a plan that isn’t a good fit.

Prescription Drug Coverage: It’s Not Always Equal

Most Medicare Advantage plans include Part D drug coverage, but it’s not uniform across plans:

• Formulary Differences: Each plan covers a different list of medications.

• Tier Structure: Generic drugs often fall in lower-cost tiers; brand-name or specialty drugs are higher.

• Preferred Pharmacies: Using preferred pharmacies can result in lower out-of-pocket costs.

In 2025, Medicare Part D has a $2,000 annual out-of-pocket cap, which can benefit high drug users. However, not all plans apply the cap the same way. It’s critical to check how your prescriptions fit into each plan’s tier and cost-sharing system.

Out-of-Pocket Limits Offer Protection—but Compare Closely

Every Medicare Advantage plan must include a maximum out-of-pocket limit (MOOP) for in-network services. In 2025:

• The MOOP for in-network services is capped at $9,350.

• Combined in- and out-of-network limits for PPOs can go as high as $14,000.

While this provides some financial protection, some plans set their MOOP closer to the maximum, especially those with lower monthly premiums. The lower the premium, the more likely you’ll pay more when you use services. Always compare the trade-off between premiums and cost-sharing.

Additional Benefits Can Add Value—but Check the Details

Medicare Advantage plans often promote extra benefits beyond Original Medicare. In 2025, common extras include:

• Dental cleanings and dentures

• Routine vision exams and glasses

• Hearing aids and screenings

• Meal delivery after hospital stays

• Transportation to medical appointments

• Over-the-counter medication allowances

• Fitness programs or wellness coaching

However, not all plans offer these benefits, and the scope can be limited. For example, a dental benefit might only cover cleanings and not major procedures. Always verify benefit limits and frequency.

Plan Structures: HMO, PPO, and More

Understanding plan structure is essential before choosing a Medicare Advantage plan:

• HMO (Health Maintenance Organization): Requires you to use in-network providers and get referrals for specialists. Usually has lower costs.

• PPO (Preferred Provider Organization): Offers more flexibility in choosing providers but comes with higher premiums and possible out-of-network cost-sharing.

• PFFS (Private Fee-for-Service): You can see any provider that accepts the plan’s payment terms, but these are increasingly rare.

• SNP (Special Needs Plan): Tailored for individuals with certain health conditions or low-income status.

Choose the structure that matches your flexibility needs, budget, and how often you access healthcare.

Why Location Affects Your Options

Medicare Advantage plans are regional. Even if a plan sounds ideal, it might not be available in your county. Plan availability, benefits, and provider networks vary by ZIP code.

Always use your ZIP code to filter plan comparisons and ensure your current providers are included in-network. In rural areas, fewer plans may be offered, or provider choices may be limited.

How to Make the Most Informed Choice

To ensure the plan you choose truly works for you:

• Review the CMS Star Rating, but don’t rely on it alone.

• Compare the Summary of Benefits and Evidence of Coverage.

• Use Medicare’s Plan Finder Tool to enter your prescriptions and provider preferences.

• Understand how referrals, authorizations, and cost-sharing apply to the services you use.

• Look beyond just premiums and focus on total annual costs.

Even a plan with great marketing can end up costing more in the long run if it doesn’t cover your needs efficiently.

Why Personalization is Key to Choosing the Right Plan

There is no universal “best” Medicare Advantage plan. What matters most is how well a plan aligns with your specific circumstances:

• Do you have chronic conditions that require frequent specialist visits?

• Do you need access to a broad network or prefer specific hospitals?

• Are your medications expensive or highly specific?

• Do you plan to travel within or outside your state?

A plan that works well for someone else may lead to frustration or higher costs for you. Personalized evaluation is crucial.

Take Action Before Enrollment Windows Close

If you’re preparing to enroll or switch Medicare Advantage plans in 2025, don’t delay. The more time you take to compare, the more likely you’ll avoid unexpected costs or access problems.

You can speak with a licensed agent listed on this website to help you review plans, answer your questions, and ensure your healthcare and financial needs are covered.