Key Takeaways

• Medicare Advantage plans evolve every year, so the plan that suited you last year might not be the best choice in 2025.

• Key changes in 2025 include updated CMS star ratings, adjustments in supplemental benefits, and shifts in out-of-pocket costs, making annual review essential.

Why You Can’t Assume Your Plan Is Still the Best in 2025

Medicare Advantage plans are not static. Each year, providers submit changes to their plan offerings, which are approved by the Centers for Medicare & Medicaid Services (CMS). These updates affect everything from the plan’s cost structure to the network of doctors, hospitals, and covered services.

If you enrolled in a plan in 2024 or earlier, the 2025 version of that plan could be significantly different. This is particularly important during the Medicare Open Enrollment Period, which runs from October 15 to December 7 each year. During this time, you have the opportunity to review and switch plans to align with your evolving healthcare needs.

What’s Changing in Medicare Advantage Plans This Year

Medicare Advantage plans in 2025 are reflecting a number of notable shifts:

Updated CMS Star Ratings

Each year, CMS assigns star ratings (1 to 5 stars) based on plan quality, member satisfaction, and health outcomes. These ratings are critical when assessing a plan’s performance.

• A higher star rating often indicates better management of chronic conditions, higher customer service satisfaction, and better preventive care outcomes.

• Plans that drop in ratings may signal declining performance.

If your plan has dropped from a 4-star to a 3-star rating in 2025, that’s a major red flag to review it.

Adjustments to Out-of-Pocket Maximums

In 2025, Medicare Advantage plans may adjust their annual Maximum Out-of-Pocket (MOOP) limits. The CMS sets a cap, but private insurers can offer plans with lower limits. For 2025:

• The maximum allowed for in-network services is $9,350.

• For combined in-network and out-of-network services, the cap is $14,000.

These figures are higher than in 2024, signaling increased potential exposure to healthcare costs if you don’t check the fine print of your current plan.

Changes in Supplemental Benefits

Supplemental benefits are a major reason why many choose Medicare Advantage over Original Medicare. These include:

• Dental, vision, and hearing services

• Transportation to medical appointments

• Over-the-counter (OTC) medication allowances

In 2025, CMS has updated its guidelines, and some plans have reduced the scope of certain benefits. For example:

• Fewer plans are offering OTC allowances and transportation benefits compared to 2024.

• A new mid-year notification requirement alerts enrollees to unused supplemental benefits between June 30 and July 31.

This change is meant to improve benefit utilization but also reveals that plans are under pressure to manage costs more tightly.

Why Star Ratings Shouldn’t Be Your Only Focus

While CMS star ratings are helpful, they don’t tell the whole story. Some 5-star plans may have narrower provider networks or limited coverage for specialized services you need.

When reviewing star ratings, also consider:

• Whether your doctors and preferred hospitals are still in-network

• If your prescription drugs remain on the plan’s formulary

• Whether prior authorizations are required for services you use frequently

CMS ratings are an important starting point, but personal fit is critical.

Medicare Prescription Drug Changes in 2025

If your Medicare Advantage plan includes prescription drug coverage (Part D), 2025 brings a major shift:

• A $2,000 annual cap on out-of-pocket drug costs has been introduced.

• The previous coverage gap (“donut hole”) no longer applies.

These changes are beneficial, especially for those with high drug expenses. However, not all plans integrate these features in the same way. You’ll need to check how your plan structures drug coverage, particularly in:

• Tiered formulary structures

• Copayment versus coinsurance models

• Monthly drug payment options introduced under the Medicare Prescription Payment Plan

Network Access and Prior Authorization

Medicare Advantage plans often use managed care models like HMOs or PPOs. That means your access to care is tied to the plan’s provider network.

In 2025:

• Some plans have narrowed their networks to control costs.

• Prior authorization rules have been modified for certain services, especially imaging and home health.

You must confirm whether your doctors, specialists, and facilities remain in-network. Even more importantly, check if services you rely on now require more paperwork or denials.

Annual Notice of Change (ANOC): Why You Must Read It

By September each year, Medicare Advantage enrollees receive the ANOC letter, outlining what’s changing in their plan for the next year.

In 2025, this document is more critical than ever because:

• It details premium changes, benefit reductions, or increases in out-of-pocket costs.

• It highlights if your drugs are being moved to higher tiers.

• It tells you if your doctors or facilities are leaving the plan’s network.

Set aside time to read the ANOC carefully. This single document can determine whether you need to change plans before December 7.

Timing Matters: Enrollment Windows You Need to Know

There are specific periods during which you can make changes to your Medicare Advantage plan:

Medicare Open Enrollment: October 15 to December 7

You can:

• Switch from one Medicare Advantage plan to another

• Disenroll and return to Original Medicare

• Join a Medicare drug plan (if returning to Original Medicare)

Medicare Advantage Open Enrollment: January 1 to March 31

You can:

• Switch to a different Medicare Advantage plan

• Disenroll and return to Original Medicare (with or without a drug plan)

These two windows allow flexibility but require timely action.

Medicare Advantage Isn’t One-Size-Fits-All

While many plans tout extra benefits or high star ratings, your decision should be rooted in your unique medical, financial, and geographic needs. Questions to ask:

• Are your specialists in-network?

• Do you expect high prescription costs in 2025?

• Will you be traveling frequently or living in multiple states?

• Do you need services like dental implants or hearing aids?

If the answers point toward limitations in your current plan, it’s a strong signal to reassess.

How to Compare Plans Without Overwhelm

With dozens of plan options, many people freeze up during decision-making. The key is to focus on:

• Coverage: Are your services and medications covered?

• Costs: What are the premiums, deductibles, and copays?

• Ratings: Has the plan’s quality improved or declined?

• Network: Are your doctors still covered?

Use Medicare’s Plan Finder tool or speak with a licensed agent listed on this website to narrow down your choices.

What This Means for You in 2025

Every year, CMS approves modifications that affect how Medicare Advantage plans serve you. In 2025, those modifications are significant. Waiting until you have a denial at the pharmacy or surprise bill in the ER is too late. The smart move is to review your plan proactively.

• Evaluate star ratings and benefit changes.

• Check in-network status and out-of-pocket exposure.

• Understand prescription drug updates.

• Mark enrollment dates in your calendar.

Staying informed means staying protected.

Ready to Reevaluate Your Medicare Advantage Plan?

If you haven’t reviewed your plan yet this year, now is the time. The 2025 changes could directly affect your care access and financial security. Even if you’re happy with your current coverage, don’t assume it hasn’t changed.

Reach out to a licensed agent listed on this website for help evaluating your options. A conversation today could prevent problems later.