Key Takeaways
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A Medicare Advantage plan that sounds appealing in advertisements may not offer the coverage or provider access that meets your actual healthcare needs.
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CMS star ratings are a useful starting point, but a 5-star plan might not be the best fit depending on your health, location, and budget preferences.
The Big Question: Are You Choosing the Best Plan or the Best-Marketed Plan?
You’ve likely seen eye-catching advertisements for Medicare Advantage plans, especially as the Annual Enrollment Period approaches from October 15 to December 7 each year. But what does it really mean for a plan to be among the “best”? The truth is, some of the most aggressively marketed plans may prioritize visibility over suitability. To make an informed decision, you need to understand what “best” really means in the context of Medicare Advantage.
Understanding What Medicare Advantage Offers
Medicare Advantage, also known as Part C, is an alternative to Original Medicare. It is provided by private companies approved by Medicare and includes all your Part A (hospital insurance) and Part B (medical insurance) coverage.
Many plans also include:
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Prescription drug coverage (Part D)
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Vision, dental, and hearing benefits
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Wellness programs and gym memberships
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Transportation or over-the-counter benefits
However, the trade-off is that these plans come with managed care rules. You typically need to use a network of doctors and may need referrals to see specialists. These restrictions can significantly affect your access to care.
CMS Star Ratings: What They Measure (and What They Don’t)
Every year, the Centers for Medicare & Medicaid Services (CMS) assigns star ratings to Medicare Advantage plans. Ratings range from 1 to 5 stars, with 5 being the highest. These ratings are based on factors like:
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Member satisfaction
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Managing chronic conditions
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Customer service
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Drug plan accuracy and safety
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Preventive services
While the star rating system is useful, it doesn’t tell the full story. For example, a 5-star plan in one area may have an entirely different provider network than a 5-star plan in another. And some high-rated plans may not include your preferred doctors, medications, or facilities.
Marketing Doesn’t Equal Value
It’s common for Medicare Advantage plans to promote features that sound universally appealing. However, marketing materials often highlight best-case scenarios. Real-world use might be very different.
What marketing might emphasize:
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“Comprehensive coverage”
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“Extra benefits”
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“National provider network”
What you need to ask:
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Does the plan actually include my current doctors and specialists?
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Are there higher out-of-pocket costs for my medications?
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Are the additional benefits useful to me specifically, or just cosmetic add-ons?
Marketing cannot replace a detailed review of the Summary of Benefits and Evidence of Coverage documents.
Local Availability Makes a Big Difference
Even if a Medicare Advantage plan ranks highly, it might not be available in your ZIP code. These plans are regional by nature, and the availability, costs, and provider networks vary not only by state but even within counties.
Some regions may have access to more competitive plans with wider networks and richer benefits. Others might only offer plans with narrow networks or more limitations.
In 2025, the variation between rural and urban coverage continues to be stark, with some rural areas having just a few plan choices. This makes your geographic location a central factor in determining which plan truly serves you best.
Hidden Costs and Rules You Might Miss
While private plans often emphasize low monthly premiums or added perks, it’s important to examine the fine print. Costs can add up depending on how you use your healthcare.
Key areas to evaluate:
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Deductibles and copayments: Even if a plan has low premiums, you could face high costs when you actually need care.
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Out-of-network coverage: Some plans offer little or no coverage if you travel outside your service area.
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Referrals: Many plans require referrals from your primary care doctor before you can see a specialist.
Also note that the 2025 maximum out-of-pocket limit for Medicare Advantage plans is $9,350 for in-network care, and $14,000 for combined in- and out-of-network services. That’s a significant potential cost if you need major care.
Drug Coverage: One of the Most Overlooked Issues
Most Medicare Advantage plans include Part D coverage. But not all formularies (lists of covered drugs) are created equal. You should:
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Check if your medications are on the plan’s formulary
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Confirm if there are any step therapy or prior authorization requirements
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Review the tier levels of your drugs and their respective costs
Also, in 2025, the Medicare Part D benefit includes a $2,000 annual cap on out-of-pocket drug costs. But that only applies if your plan fully integrates with this feature and you’re not in a standalone drug plan outside Medicare Advantage.
Convenience Features Can Be Misleading
Some Medicare Advantage plans market convenience-oriented benefits like over-the-counter allowances, grocery cards, or fitness memberships. These extras may be appealing, but you should assess their real value.
Ask yourself:
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Do you regularly use these services?
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Are they worth higher out-of-pocket costs elsewhere?
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Are they included at no cost, or are they bundled with trade-offs like limited networks?
For many beneficiaries, it’s more important to have consistent access to specialists or lower prescription costs than to have extra perks that might go unused.
Telehealth: Expanding, But Not Always Equal
Telehealth saw a major expansion in 2020 and remains a focus in 2025. While many Medicare Advantage plans include virtual care options, the quality and scope of telehealth benefits vary.
When evaluating this feature:
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Find out whether telehealth includes specialty care or only basic services
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Determine whether virtual visits count toward deductibles and out-of-pocket limits
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Ensure telehealth services meet your ongoing health needs, not just urgent care
Again, marketing may tout “24/7 virtual care,” but the actual services could be limited.
Plan Changes from Year to Year
Medicare Advantage plans can change annually. What was considered a top-rated plan in 2024 may be significantly different in 2025. Providers may leave the network, formularies may be updated, and benefits may shift.
Always review the Annual Notice of Change (ANOC) letter sent each fall. This outlines:
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Changes to premiums, copayments, and deductibles
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Alterations to the provider or pharmacy network
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Adjustments to covered drugs and tiers
Choosing a plan without reviewing these details each year can leave you exposed to surprise costs or reduced access to care.
Enrollment Periods Are Limited
It’s important to understand when you can join or switch Medicare Advantage plans:
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Initial Enrollment Period (IEP): A 7-month window surrounding your 65th birthday
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Annual Enrollment Period (AEP): October 15 to December 7 every year
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Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31, but only for those already enrolled in an MA plan
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Special Enrollment Periods (SEPs): Triggered by life events like moving or losing coverage
Outside these timeframes, you may not be able to make changes unless you qualify for a Special Enrollment Period.
Evaluating What “Best” Means for You
Ultimately, the best Medicare Advantage plan is the one that aligns with your personal needs, not just the one that advertises the most features. You’ll want to assess:
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Your preferred doctors and hospitals
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Your prescription medications
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Frequency of specialist visits
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Desire for travel coverage
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Tolerance for managed care rules
A plan that earns high star ratings but excludes your specialists or has high drug costs may not serve you well, regardless of its national reputation.
What to Focus On Instead of Just Marketing
To filter through the noise, focus on the following before enrolling:
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Review CMS Star Ratings, but don’t rely on them alone
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Check the plan’s provider directory to confirm your doctors are in-network
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Use Medicare Plan Finder to compare costs, benefits, and coverage for your ZIP code
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Evaluate total out-of-pocket exposure, including copays and drug costs
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Read the Evidence of Coverage (EOC) document carefully
A Smarter Approach to Medicare Advantage Selection
If you want to avoid being swayed by aggressive advertising and potentially misleading promotions, it’s essential to take a methodical approach. Choosing based on real-world factors will protect you from gaps in care, surprise bills, and unfulfilled expectations.
Speak with a licensed agent listed on this website who can help you analyze your health needs, budget, and preferences to find a Medicare Advantage plan that truly fits.
