Key Takeaways
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Just because a Medicare Advantage plan is heavily marketed or popular doesn’t mean it’s the right one for you. Many of the worst-performing plans rely on name recognition to draw in enrollees while offering limited provider access, confusing benefits, or poor satisfaction ratings.
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Pay close attention to each plan’s star rating, network size, prior authorization rules, and out-of-pocket limits. These details often reveal more about the plan’s performance than its advertising.
Why Visibility Doesn’t Equal Quality in Medicare Advantage
The Medicare Advantage marketplace is crowded, and you probably see a few plan names far more than others. Their visibility is no accident. These plans often spend heavily on advertising campaigns during Open Enrollment, which runs from October 15 through December 7 each year. But the truth is that some of the most recognizable plans may not be offering you the best value.
Highly advertised plans often draw attention with perks or benefits that sound generous on paper. But once you enroll and start using the plan, you might uncover issues like:
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Strict prior authorization rules
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Limited provider networks
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High out-of-pocket costs for routine services
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Frustrating customer service experiences
Understanding Star Ratings and Why They Matter
In 2025, Medicare continues to use its 5-star rating system to evaluate the quality and performance of Medicare Advantage plans. Plans receive ratings from 1 to 5 stars based on factors like member experience, access to care, management of chronic conditions, and plan responsiveness.
If you’re evaluating plans, remember:
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5-star plans are considered excellent and are eligible for year-round enrollment via a Special Enrollment Period.
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3-star plans meet average expectations but may have gaps in service or satisfaction.
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Plans rated below 3 stars for three consecutive years are flagged by Medicare as consistently underperforming.
Despite this, many low-rated plans continue to attract enrollees simply because they are more visible in ads and mailers. If a plan is rated 2.5 stars or below in 2025, that should raise a red flag.
The Most Common Issues With Poor-Performing Plans
While every Medicare Advantage plan differs in structure, the worst ones tend to share a few troubling characteristics. These issues may not be obvious until after enrollment, but they significantly impact your ability to receive timely and affordable care.
Limited or Narrow Provider Networks
Some of the lowest-rated Medicare Advantage plans operate with narrow provider networks. This means fewer doctors, specialists, and hospitals are available to you. You might discover too late that your preferred physician is no longer in-network or that you must travel far for certain treatments.
A narrow network may also:
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Prevent access to top-tier hospitals or specialty care
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Require frequent referrals for simple services
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Cause you to switch primary care providers midyear
Excessive Prior Authorizations
Another red flag is a high volume of required prior authorizations. Prior authorization is when your doctor must get approval from your plan before providing certain services, treatments, or medications.
The worst plans often use this tool to delay or deny care. In 2025, prior authorizations remain a source of frustration for many enrollees, especially those managing chronic or complex conditions.
Warning signs include:
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Delays in getting approval for imaging, tests, or procedures
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Denials for specialist referrals or prescriptions
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Excessive paperwork that burdens both you and your providers
Out-of-Pocket Costs That Aren’t Obvious Upfront
You may be drawn to a plan because of a lower monthly premium or a flashy benefit. But many poor-quality plans make up for low premiums with high cost-sharing. In 2025, Medicare Advantage plans are allowed to set their own copays, coinsurance, and out-of-pocket maximums within Medicare’s limits.
Plans at the bottom of the star rating scale often include:
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Higher-than-average copays for doctor visits or prescriptions
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Out-of-network costs that catch you off guard
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Annual out-of-pocket maximums closer to the $9,350 in-network limit allowed by Medicare in 2025
While every plan must have an annual out-of-pocket cap, the fine print matters. It affects how quickly you reach that cap and what costs count toward it.
Poor Customer Service and Communication
Low-rated plans often struggle with member communication. You may experience difficulty getting clear answers about your benefits, trouble resolving billing issues, or delayed responses when requesting help.
Look out for these signs of poor service:
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Long wait times on customer service lines
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Unclear coverage explanations
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Complicated processes for filing appeals or grievances
In 2025, digital tools and member portals are expected to improve communication, but not all plans are keeping up. Those that don’t modernize leave members at a disadvantage.
Red Flags You Can Spot Before Enrolling
To avoid ending up with one of the worst Medicare Advantage plans, take time to review the following:
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Star Rating: Anything below 3 stars should be questioned. Look at why the score is low.
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Network Directory: Confirm your doctors, specialists, and nearby hospitals are included.
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Drug Formulary: Make sure your medications are covered and check tier placement.
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Out-of-Pocket Maximum: Compare this across plans, especially if you have frequent medical needs.
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Prior Authorization Policies: Review the list of services requiring approval. More isn’t better.
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Member Reviews and Surveys: Check satisfaction scores on Medicare.gov to spot trends in complaints.
Many poor-performing plans fail to explain their limitations upfront, so you need to dig a little deeper during your comparison process.
Why Popularity Doesn’t Mean Better Care
Just because a plan is heavily promoted doesn’t mean it offers better coverage. In fact, popularity can sometimes work against the plan’s performance. High enrollment numbers can overwhelm customer service departments, delay claims processing, or dilute provider access.
Also, popular plans may rely more on branding than quality, and you might find:
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Benefits change from year to year without much notice
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Access to supplemental benefits is more limited than advertised
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Provider contracts are dropped midyear
These challenges are common in large plans that stretch their resources too thin. Always verify the current year’s benefits before assuming continuity.
Evaluating Plan Performance Over Time
Don’t judge a Medicare Advantage plan based on one year alone. Plans that consistently receive low ratings, year after year, are more likely to be problematic.
CMS updates star ratings annually based on the most recent performance data. In 2025, be cautious if you see a plan that:
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Held a rating below 3 stars in both 2023 and 2024
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Failed to improve service areas such as member complaints or chronic condition management
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Continues to receive notices from CMS for poor performance or compliance issues
Stability matters. If a plan can’t demonstrate consistent improvement, it may not be worth your trust.
Don’t Choose Based on Perks Alone
Many of the most visible Medicare Advantage plans advertise extra perks like dental, vision, fitness memberships, or meal delivery. While these benefits are attractive, they should not outweigh core coverage issues.
A low-rated plan might still include these perks, but if it fails to cover critical services or makes it hard to access specialists, those extras won’t make up the difference.
Focus on the essentials first:
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Adequate network size
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Transparent cost-sharing
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Reliable access to care
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Positive member experiences
Then consider which extras genuinely enhance your health and daily life.
Staying Informed Throughout the Year
If you’re already enrolled in a Medicare Advantage plan, you can still assess whether it’s working well for you. Watch for signs that may suggest it’s time to change plans during the next enrollment window:
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Surprise bills from out-of-network providers
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Canceled appointments due to dropped contracts
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Long delays in prior authorization approvals
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Increases in drug or service costs
Use the Annual Notice of Change (ANOC) mailed each September to compare upcoming changes to your current plan. This helps you prepare for the Open Enrollment Period starting in October.
Pay Attention to How a Plan Treats Chronic Conditions
If you have diabetes, heart disease, or another chronic condition, your Medicare Advantage plan should help you manage it effectively. Unfortunately, the worst plans often provide poor coordination and limited disease management support.
Warning signs for chronic care include:
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Minimal follow-up from case managers or health coaches
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High costs for ongoing lab work or specialist visits
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Delayed access to durable medical equipment or insulin
In 2025, Medicare continues to emphasize chronic care management in its star rating calculations. Plans that lag in this area may be placing their members at risk.
Be Wary of Plans with High Turnover
Plans that frequently change their provider networks or benefit structures can cause unnecessary disruptions. This often occurs in the lowest-rated Medicare Advantage plans, where instability and turnover are common.
Stay cautious if you notice:
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Major shifts in what’s covered from year to year
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Providers leaving the network with little notice
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Restructured drug formularies each year
Consistency is a critical element in managing your care. Unpredictable plans create stress and financial uncertainty.
The Right Questions Can Save You Time and Trouble
Before enrolling, ask:
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How has the plan’s star rating changed over the last three years?
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Are my current providers and prescriptions still covered?
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What services require prior authorization?
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What are the in-network and out-of-network maximums?
When you evaluate plans with these questions, you’re less likely to fall for a familiar name and more likely to find a plan that fits your needs.
Make a Smarter Choice This Enrollment Season
As you consider your Medicare Advantage options for 2025, resist the urge to choose based on what sounds familiar or popular. The worst plans often hide behind heavy marketing and attractive extras, while failing to meet your actual healthcare needs.
Instead, focus on what really matters: star ratings, network access, cost-sharing, customer service, and chronic care management. These are the factors that determine how well a plan works for you.
If you need help reviewing your options or identifying hidden risks in a plan you’re considering, reach out to a licensed agent listed on this website. Personalized guidance can help you avoid the plans that look good on the surface but fail you when you need them most.
