Key Takeaways

• CMS star ratings can be a helpful starting point, but a highly rated Medicare Advantage plan is not automatically the best fit for your individual situation. You need to dig deeper into its actual benefits, network, and cost-sharing structure.

• In 2025, more Medicare Advantage plans than ever offer attractive perks, but these extras should never distract from evaluating the core elements that protect your access to care and long-term affordability.

Understanding the CMS Star Rating System

Every year, the Centers for Medicare & Medicaid Services (CMS) publishes a rating for each Medicare Advantage plan, scoring them on a scale from 1 to 5 stars. These ratings are made public each fall ahead of the Medicare Open Enrollment Period, which runs from October 15 to December 7. The goal is to help beneficiaries make more informed choices.

The CMS star ratings are based on over 40 performance measures across categories such as:

• Chronic condition management

• Preventive screenings and vaccinations

• Timely access to care

• Customer service responsiveness

• Appeals handling and member complaints

• Drug safety and accuracy of pricing information

Plans with a 5-star rating are deemed to deliver excellent performance across these metrics. But while these criteria are useful for evaluating overall quality, they do not account for how well a plan fits you personally.

The Limits of Relying on Ratings Alone

In 2025, more than half of Medicare Advantage enrollees are in plans with 4 or 5 stars. That sounds promising, but even a plan with top marks could end up costing you more or providing less access to care, depending on your individual circumstances.

Here’s what CMS ratings don’t tell you:

• Whether your current doctors and specialists are in-network

• If the plan covers your specific prescription medications

• How much you’ll pay for common services like lab tests, specialist visits, or hospital stays

• Whether you need referrals to see specialists

A 5-star rating reflects quality for the general population, but your health needs are unique. Blindly following ratings without deeper evaluation could leave you facing surprise expenses or frustrating barriers to care.

What You Should Actually Look for in a Medicare Advantage Plan in 2025

When comparing plans, use star ratings as a filter—but not as the final word. Instead, focus on key features that shape your healthcare experience.

1. Annual Out-of-Pocket Limits

Medicare Advantage plans are required to cap your yearly spending on in-network care. For 2025, these limits can be as high as:

• $9,350 for in-network care

• $14,000 for combined in- and out-of-network care (if your plan allows out-of-network use)

Plans with lower out-of-pocket limits may offer better protection if you have chronic conditions, require frequent care, or want financial predictability.

2. Prescription Drug Coverage (Part D)

Most Medicare Advantage plans bundle drug coverage. For 2025:

• The annual out-of-pocket cap for prescriptions is $2,000

• The coverage gap (donut hole) has been eliminated

• Beneficiaries can opt for a monthly payment option to manage prescription costs over time

Even with these improvements, formularies (the list of covered drugs) vary widely. Some plans may not cover a brand-name medication you rely on. Others may require prior authorization. Always check your medication list against the plan’s formulary.

3. Provider Network Access

Not all plans include the same doctors, clinics, or hospitals. In 2025, provider directories are more transparent, but still need to be verified.

Ask:

• Are your primary care doctor and specialists in the network?

• Are local hospitals and urgent care centers included?

• Are referrals required to see specialists?

Out-of-network care often costs more and may not be covered at all, depending on the plan type (HMO vs PPO).

4. Cost-Sharing Requirements

Look beyond the premium. Medicare Advantage plans often have cost-sharing through:

• Copayments for doctor visits or outpatient procedures

• Coinsurance for hospital stays, surgeries, or diagnostic services

• Tiered drug costs depending on generic vs brand-name drugs

These expenses can add up quickly, especially if you have ongoing medical needs. Carefully compare the total estimated yearly cost.

5. Extra Benefits: Nice to Have, But Not the Priority

Plans often advertise perks like:

• Dental and vision coverage

• Hearing aids and exams

• Gym memberships

• Over-the-counter medication allowances

• Transportation assistance

These can be valuable, but they vary in quality and access. For instance, dental coverage may only include cleanings and exams, not major work. Don’t prioritize these benefits over core health coverage unless they are vital to you.

Why One Size Doesn’t Fit All

Many beneficiaries mistakenly assume:

• A high star rating guarantees affordability

• All Medicare Advantage plans are more or less the same

• Extra benefits mean better overall coverage

In truth, two 4.5-star plans in the same ZIP code can differ drastically in how they handle hospital stays, chronic care, or prescription coverage. The best plan for someone with diabetes will not be the same as the best plan for someone who only sees a doctor once a year.

What fits your neighbor may be a poor fit for you.

Key Medicare Enrollment Periods to Watch

Timing matters. The plan you choose—or fail to update—will stay with you until the next opportunity to switch. Here’s when you can make changes:

• October 15 to December 7 (Annual Enrollment Period): Change from Original Medicare to Medicare Advantage, switch Advantage plans, or join/drop Part D.

• January 1 to March 31 (Medicare Advantage Open Enrollment Period): Switch from one Medicare Advantage plan to another or return to Original Medicare.

• Special Enrollment Periods: These occur after qualifying events, like moving, losing other insurance, or becoming eligible for Medicaid.

Each fall, new CMS star ratings are released. Be sure to evaluate the latest scores before Open Enrollment.

Metrics to Track That Matter More Than Stars

Instead of focusing solely on the star rating, measure these:

• Inpatient and outpatient cost structures

• Annual caps on out-of-pocket expenses

• Coverage of your specific drugs

• Ease of access to care

• Flexibility with travel or snowbird lifestyles

• Telehealth access and home-based services

Plans that score well on coordination of care, access to specialists, and chronic disease support may serve you better than a plan that merely offers extra perks.

When to Use CMS Ratings as a Tie-Breaker

CMS star ratings can be useful when you’re down to a few similar plans. They can help you:

• Eliminate poorly performing options (especially 2.5 stars or lower)

• Prioritize plans with good customer satisfaction scores

• Identify plans with a proven track record of preventive care delivery

If two plans offer the same drug coverage, premium, provider network, and out-of-pocket cap, the star rating can serve as the final deciding factor.

How to Make a Personalized Medicare Advantage Choice

In 2025, over 3,800 Medicare Advantage plans are offered across the country. That’s a massive menu of options—too many to navigate without help.

To make a smart choice:

• Use the Medicare Plan Finder tool on the official Medicare site

• Review the Annual Notice of Change (ANOC) from your current plan to see what’s changing

• Make a list of your current:

  • Doctors and specialists

  • Hospitals and clinics

  • Prescription medications

  • Preferred pharmacies

  • Monthly medical budget

Then, reach out to a licensed agent listed on this website for guidance. They can help you sort through options based on your ZIP code, preferences, and needs—without pushing a specific carrier or product.

Make Your Plan Work for You, Not the Other Way Around

In the end, the goal isn’t to find the most popular Medicare Advantage plan—it’s to find the right one for you. CMS ratings can be helpful tools, but they only scratch the surface.

Plans differ by region, health condition, and cost-sharing design. Your best plan may not have the most stars, but it will:

• Give you reliable access to care

• Limit your out-of-pocket risk

• Cover your essential prescriptions

• Include the doctors and hospitals you trust

If you feel unsure or overwhelmed, speak with a licensed agent listed on this website. They can offer independent support tailored to your health, lifestyle, and financial goals.