Key Takeaways

• The worst Medicare Advantage plans often appear highly attractive in advertisements but can hide severe restrictions, low star ratings, and high out-of-pocket risks.

• Relying solely on ads without reviewing plan documents, networks, and CMS ratings can lead you into plans that underdeliver when you need care the most.

Flashy Ads Aren’t the Whole Story

Medicare Advantage plan advertisements are everywhere during open enrollment season. You’ve likely seen smiling faces, long lists of extra benefits, and promises of simplicity. But here’s the hard truth: the worst Medicare Advantage plans know how to market themselves. What they don’t always highlight are the restrictions, limitations, and poor performance ratings that can affect your access to care.

TV commercials, mailers, and online banners can give the illusion that all plans offer exceptional value. In reality, some plans prioritize enrollment numbers over actual member satisfaction. You could sign up for a plan that looks impressive in an ad but ends up limiting your doctors, delaying your treatments, and costing you more over time.

What CMS Star Ratings Really Tell You

The Centers for Medicare & Medicaid Services (CMS) uses a 5-star rating system to evaluate Medicare Advantage plans each year. These ratings reflect:

• Member satisfaction

• Health care quality

• Management of chronic conditions

• Preventive care services

• Customer service experiences

In 2025, a 3-star or lower rating is a clear warning. It means the plan is performing below average in multiple categories. A 2-star or 1-star plan suggests major shortcomings in care delivery or customer satisfaction.

Low-rated plans can still advertise heavily, and many do. CMS restricts certain promotional language for these plans, but that doesn’t mean they can’t appeal to emotions or highlight surface-level perks. If you see a plan with a CMS star rating under 3, it’s worth reconsidering. Higher-rated plans have a consistent track record of delivering care that meets or exceeds federal benchmarks.

Common Features of the Worst Medicare Advantage Plans

While plans differ by location, the lowest-performing ones often share troubling characteristics. Recognizing these red flags can help you avoid a poor choice:

Limited Provider Networks

Many plans with lower CMS ratings restrict you to a narrow network of doctors and hospitals. If you need a specialist, you might have to:

• Wait weeks for an appointment

• Travel farther than expected

• Get prior authorization for basic services

This network limitation can be particularly risky if your health changes or you move. Some plans make switching doctors within the network difficult, further complicating access.

Excessive Prior Authorizations

Prior authorizations are administrative hurdles that require your doctor to get approval from the plan before certain tests or treatments are covered. Poorly rated plans often overuse prior authorization, even for:

• Diagnostic imaging like MRIs

• Outpatient surgeries

• Rehabilitation services

These delays can jeopardize timely care. In 2025, CMS has tightened rules around prior authorization, but plans still have leeway, especially those with lax oversight or poor administrative performance.

Unpredictable Out-of-Pocket Costs

Although Medicare Advantage plans must cap annual in-network out-of-pocket costs (in 2025, that maximum is $9,350), the worst plans come dangerously close to this limit with frequent copayments and high coinsurance rates.

Examples include:

• $50 to $75 for urgent care

• 30% coinsurance for outpatient surgery

• 40% coinsurance for out-of-network specialists (if allowed at all)

This cost structure is rarely disclosed upfront in a clear way. Ads highlight perks but may bury cost details in fine print or leave them out entirely.

Lack of Transparency and Customer Support

Low-rated plans typically receive poor feedback on their customer service. Issues you may encounter include:

• Long wait times to reach representatives

• Inconsistent information

• Complicated billing statements

When problems arise, such as denied claims or incorrect charges, these plans may delay resolution, causing stress and financial uncertainty.

Inadequate Drug Coverage

In 2025, prescription drug benefits are subject to new protections, including a $2,000 cap on out-of-pocket drug costs under Part D. However, the worst plans may:

• Use restrictive formularies that exclude common medications

• Require step therapy before approving brand-name drugs

• Change tiers and prices midyear

Even with the new cap, poorly managed plans can make accessing medication unnecessarily difficult.

The Danger of Relying on Perks in Ads

Many Medicare Advantage ads emphasize add-ons like dental, vision, hearing aids, gym memberships, or over-the-counter benefits. While these perks may be helpful, they are not a substitute for reliable medical coverage.

In low-rated plans, these extra benefits may be:

• Hard to access due to limited provider availability

• Tied to high out-of-pocket costs

• Advertised prominently while serious plan flaws are downplayed

The worst plans know that offering perks gets attention. But those extras should not distract you from evaluating how the plan performs in actual medical care and customer satisfaction.

Misleading Enrollment Tactics Are Still in Use

Despite efforts by CMS to curb aggressive marketing, some bad actors continue to use misleading language in advertisements. In 2025, you may still encounter:

• Ads implying all Medicare beneficiaries qualify for the same benefits

• Promises of “more benefits at no cost” without explaining limitations

• Fine print that excludes critical eligibility requirements

If you’re enrolled in Medicare, especially if you’re new to it, these messages can be confusing. Trusting them without deeper research may lead you into a plan that sounds generous but delivers disappointing results.

Why Plans With Low Ratings Still Exist in 2025

It’s reasonable to wonder why low-rated plans are even allowed to continue. In short, CMS does monitor them and can issue corrective actions, but these plans often:

• Improve slightly to avoid termination

• Operate in underserved areas where choices are limited

• Rebrand or change names while retaining core problems

Unless a plan consistently fails to improve over several years, it may still be available for enrollment, even with a track record of poor performance.

How to Protect Yourself During Open Enrollment

If you want to avoid falling into one of the worst Medicare Advantage plans, it helps to take a few proactive steps:

1. Check the CMS Star Rating

Always confirm a plan’s current CMS rating. In 2025, you can find this on the official Medicare website or by speaking to a licensed agent listed on this site.

2. Read the Summary of Benefits and Evidence of Coverage

Don’t rely on marketing flyers or TV ads. Look at the official plan documents, which outline:

• Cost-sharing requirements

• Network limitations

• Prescription drug coverage

3. Verify Network Access

Make sure your preferred doctors, hospitals, and pharmacies are in-network. Also, check how often prior authorization is required for services.

4. Evaluate Total Cost, Not Just Premiums

A low premium does not guarantee low overall costs. Factor in:

• Copayments

• Coinsurance

• Deductibles

• Out-of-pocket maximums

5. Speak With a Licensed Agent

You don’t have to make these decisions alone. A licensed agent can compare multiple plans in your area and help you identify which ones offer both benefits and reliability.

What You See in Ads Is Just the Beginning

When you enroll in a Medicare Advantage plan, you’re committing for a full year unless you qualify for a special enrollment period. A flashy ad might last 30 seconds, but the plan’s impact on your health and finances can last much longer.

Take your time. Review the facts. And don’t let an ad dictate your health care future.

Take the Right Step Before You Sign Up

Choosing a Medicare Advantage plan is one of the most important health decisions you’ll make each year. Unfortunately, relying on advertising alone can steer you into one of the worst plans without even realizing it.

The CMS star rating system exists to give you an objective way to evaluate plans. Pay attention to it. Understand the costs, access rules, and customer support history before you commit.

If you want personal guidance from someone who understands the details behind these plans, speak with a licensed agent listed on this website. They can help you make a confident, well-informed decision that protects your health and your wallet.