Key Takeaways

• Many people switch Medicare Advantage plans because even the “best” plans often don’t deliver the same experience for everyone. Changes in costs, networks, and personal health needs drive reevaluation.

• Star Ratings from CMS help assess plan quality, but they don’t guarantee that a plan will meet your specific priorities, especially when provider access or coverage limits shift.

Why Plan Switching Happens So Frequently

It might seem contradictory that the best Medicare Advantage plans attract large enrollments while many enrollees still leave them. However, this is a common occurrence during the Medicare Annual Enrollment Period, which runs from October 15 to December 7 each year. During this time, millions of beneficiaries reconsider their current plans and switch for various reasons.

Several patterns explain this trend:

• Provider Networks Change: A primary care doctor or specialist you’ve seen for years may suddenly become out-of-network. If your plan no longer includes your preferred providers, switching becomes necessary.

• Prescription Coverage Adjustments: Formularies, or the list of covered drugs, can change yearly. If your medication moves to a higher tier or is dropped entirely, your out-of-pocket costs can spike.

• Out-of-Pocket Expenses Rise: Medicare Advantage plans are known for offering coordinated care, but they come with different cost structures. Copayments, deductibles, and maximum out-of-pocket limits may increase annually.

• Plan Benefits Evolve: Supplemental benefits like dental, vision, hearing, transportation, or fitness programs may be reduced or replaced. These changes can tip the scales for beneficiaries evaluating the value they receive.

What the CMS Star Ratings Really Reflect

The Centers for Medicare & Medicaid Services (CMS) use a 5-star rating system to evaluate Medicare Advantage plans. These ratings consider multiple factors, including:

• Member satisfaction

• Preventive care services

• Chronic condition management

• Customer service performance

• Complaints and disenrollment rates

Plans with a 5-star rating are generally considered excellent. But even highly rated plans can fall short for individuals if their needs don’t match the plan’s strengths. For example, a plan might excel in diabetes management but offer fewer mental health specialists.

In 2025, fewer plans have 5-star ratings compared to prior years, largely due to stricter CMS criteria. This signals that while many plans are still good, beneficiaries must look deeper than the star ratings alone.

Why the “Best” Plan Might Not Be Best for You

Medicare Advantage plans vary widely in network size, referral rules, service areas, and cost-sharing. A plan that’s perfect for one person could be impractical for someone else, even in the same ZIP code. You should consider the following:

• Provider Access: Does the plan include your hospital, primary doctor, and specialists?

• Referrals Needed: Do you need a referral to see a specialist, and does that align with how you use healthcare?

• Service Area: Some plans only work within specific counties or regions. If you travel often or live part-time in another state, this can become a barrier to care.

• Chronic Illness Care: Are your conditions addressed through targeted programs, or will you face limitations in care coordination?

All of these factors can make a highly rated plan unsuitable for your personal needs.

The Role of Annual Changes in Plan Design

Every year, Medicare Advantage plans update their Summary of Benefits and Evidence of Coverage documents. These updates reflect changes to:

• Premiums (general costs, not specific to private plans)

• Deductibles

• Copayments and coinsurance

• Drug tiers and pharmacy access

• In-network and out-of-network rules

These shifts may lead to dissatisfaction. For example, a plan with a strong 2024 benefit set might make cost-containment changes in 2025 that reduce the value for certain members. Beneficiaries who don’t compare their Annual Notice of Change (ANOC) may miss these adjustments and experience unexpected costs.

Supplemental Benefits Sound Great, Until They Change

Medicare Advantage plans often include extras beyond what Original Medicare covers. In 2025, most plans continue to offer benefits like:

• Dental cleanings and exams

• Vision exams and eyewear allowances

• Hearing aids

• Transportation to medical appointments

• Over-the-counter allowances

However, these benefits are not standardized. The scope and quality of each benefit vary between plans and even year to year within the same plan. If you rely heavily on one of these benefits and it’s reduced or removed, you might be forced to switch to maintain access.

This is especially common with hearing aid coverage or dental benefits. What was once a generous allowance may be cut significantly, making other plans more attractive.

How Medicare Marketing Influences Expectations

Marketing materials can make every plan seem like the best choice. But beneficiaries should approach glossy brochures and bold claims with caution.

In 2025, CMS has tightened marketing regulations to prevent misleading representations. Even so, differences between marketing promises and actual coverage details often go unnoticed until after enrollment. This leads to dissatisfaction and contributes to the high switch rate.

To avoid disappointment, always compare actual coverage documents, not just advertisements. Be cautious of promises like low copays or generous extras without confirming what is included in the fine print.

Open Enrollment and the Switch Window

Most plan switching happens during the Annual Enrollment Period (October 15 to December 7), but it’s not the only opportunity. Other windows include:

• Medicare Advantage Open Enrollment Period (January 1 to March 31): If you’re already in a Medicare Advantage plan, you can make a one-time switch to another Advantage plan or return to Original Medicare.

• Special Enrollment Periods (SEPs): These are triggered by events like moving out of your plan’s service area, qualifying for Medicaid, or losing employer coverage.

If you realize your plan doesn’t meet your needs, waiting until the next fall enrollment could mean enduring inadequate coverage for months. Understanding your switch rights can help you act sooner.

Travel and Emergency Coverage: A Common Pain Point

Many Medicare Advantage plans restrict coverage to network providers within their geographic area. While emergency care is covered nationwide, routine or specialist care during travel is usually not.

This becomes a problem for snowbirds, part-time residents, or anyone who travels frequently. If your plan has no national network or reciprocal arrangements, you may face significant out-of-pocket costs while away from home. Plans may also limit telehealth options outside your state.

This geographic rigidity prompts many beneficiaries to switch to a plan with broader flexibility or even return to Original Medicare paired with a Medigap policy.

Customer Service and Ease of Use

You should also consider how responsive and helpful a plan’s customer service is. Even a well-structured plan can feel frustrating if it’s difficult to:

• Get prior authorizations

• Resolve billing issues

• Receive claim decisions promptly

Customer experience is part of the CMS Star Rating calculation, but individual experiences still vary. A string of delays or confusion during the year can quickly erode confidence in your current plan.

Many people switch after encountering poor communication, excessive paperwork, or denied claims they didn’t expect.

Health Status Can Change—and So Should Your Plan

Your health in 2025 may not be the same as it was in 2024. Perhaps you were relatively healthy last year but now require routine specialist care, expensive prescriptions, or chronic disease management.

Plans that once seemed adequate can become restrictive if they don’t offer enough support for evolving conditions. In those cases, switching to a plan with better care coordination, disease-specific programs, or expanded drug coverage is a smart move.

Similarly, if your health has improved, you may want a plan with fewer monthly costs and less intensive services. Matching your plan to your current health needs should be a regular practice.

The Search for Better Value

In a competitive Medicare landscape, “best” is subjective. Some beneficiaries want predictability in monthly expenses, while others care more about provider choice or wellness perks.

As a result, switching plans doesn’t mean the original choice was wrong. It often reflects a change in priorities, new information, or simply the annual reality that plans change and so do you.

Making a switch is often a smart strategy to get better alignment between cost, access, and care. It doesn’t mean the plan you left was bad, just that it no longer serves you best in 2025.

Staying in Control of Your Medicare Advantage Journey

Medicare Advantage is a flexible but complex alternative to Original Medicare. Even highly rated plans can underperform for certain people depending on how well the plan matches individual preferences, provider access, and budget tolerance.

Switching isn’t a sign of failure. It’s a sign that you’re paying attention, reevaluating your needs, and taking proactive steps to ensure your health plan works for you.

If you’re unsure whether your current plan is still a good fit, now is the time to ask questions, review plan details, and speak with a licensed agent listed on this website to explore your options.