Key Takeaways

• Medicare Advantage plans with poor CMS star ratings often limit provider access, impose unexpected costs, and underdeliver on promised benefits.

• You can avoid the worst plans by reviewing their annual changes, understanding cost-sharing rules, and checking the plan’s customer satisfaction and service metrics.

The Appearance of a Good Deal Can Be Misleading

When you’re comparing Medicare Advantage plans, you may encounter plans that look appealing at first glance. The promises are often dressed in convenience, extra perks, and smooth sales pitches. However, some of the worst Medicare Advantage plans use this charm to distract from what really matters: your actual healthcare access and long-term costs.

Even in 2025, many of these plans are aggressively marketed during the annual Medicare Open Enrollment Period, which runs from October 15 to December 7. The brochures and advertisements may highlight added benefits and flexibility, but rarely do they point to network restrictions, prior authorization hurdles, or poor customer service.

What Makes a Medicare Advantage Plan “Bad” in 2025?

Medicare Advantage plans vary widely in quality, and what makes a plan one of the worst is usually a combination of hidden limitations, low performance ratings, and high denial rates.

Low CMS Star Ratings

Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage plans using a star rating system that ranges from 1 to 5 stars. A 5-star rating indicates excellent performance, while 2.5 stars or lower flags poor quality.

In 2025, several plans remain at 2.5 stars or below. These plans tend to:

• Score poorly in member experience surveys

• Deliver subpar customer service

• Fail in managing chronic conditions effectively

• Have lower rates of preventive care

You can find the star rating for each plan on the official Medicare website. If you’re considering a plan rated 3 stars or below, you should take that as a major warning sign.

Limited Provider Networks

Some Medicare Advantage plans restrict you to a narrow list of in-network providers. This can severely limit your access to specialists and preferred hospitals. If you go out-of-network, you might face steep out-of-pocket costs or complete denial of coverage.

In 2025, provider access is still one of the most common complaints among enrollees in poorly rated plans. You may only discover the limitations when you try to book an appointment with a specialist or need a specific procedure.

Excessive Prior Authorization Requirements

Prior authorization is the process of getting approval from the plan before receiving certain services. The worst Medicare Advantage plans in 2025 still rely heavily on this tactic, leading to delayed care or outright denials.

These plans often require prior authorization for:

• Advanced imaging (like MRIs or CT scans)

• Inpatient hospital stays

• Skilled nursing facility care

• Physical therapy

While some prior authorization is expected in managed care, overuse of this mechanism can result in care being withheld or delayed unnecessarily.

Hidden Costs and Cost-Sharing Rules

Low monthly premiums might draw you in, but the worst Medicare Advantage plans can end up costing you far more over the year. In 2025, you still need to be cautious about:

• High out-of-pocket maximums (up to $9,350 for in-network care and $14,000 for combined services)

• Expensive cost-sharing for chemotherapy, dialysis, or hospital stays

• Tiered drug formularies with high coinsurance for brand-name medications

What looks like an affordable plan can quickly become a financial burden if you have a health emergency or chronic condition.

Poor Member Services and Complaint Rates

Some plans consistently rank poorly in CMS categories like customer service and handling of appeals and grievances. In 2025, you should pay close attention to how a plan handles:

• Timeliness of service

• Responsiveness to calls and messages

• Appeals for denied services

A poorly run plan can make it difficult to resolve issues, get prior authorizations approved, or even access basic information.

How These Plans Keep Selling Despite Low Ratings

It might surprise you that low-rated Medicare Advantage plans continue to be offered year after year. In many cases, these plans use aggressive marketing strategies and make use of sales agents who highlight superficial benefits while glossing over the limitations.

Open Enrollment season becomes particularly risky. Enrollees are flooded with advertising and phone calls, and unless you’re reading every document carefully, it’s easy to miss the red flags. In addition, plans can change their benefits and network coverage from year to year, and the worst ones often make these changes in a way that creates confusion or obscures their true value.

Recognizing Warning Signs Before You Enroll

To avoid selecting one of the worst Medicare Advantage plans in 2025, you need to know what signs to look for during your plan comparison process.

1. Star Rating of 2.5 or Lower

Plans rated below 3 stars by CMS have documented issues with care coordination, customer satisfaction, and chronic care management. A consistently low rating over two or more years is especially concerning.

2. Vague or Generic Plan Materials

If a plan’s summary of benefits lacks detail or uses broad terms like “access to providers” without listing actual networks or limitations, that’s a red flag.

3. No Clear Out-of-Pocket Costs

Plans that hide cost-sharing structures or have unusually high out-of-pocket maximums should be reviewed with caution. Always look at:

• Specialist visit copayments

• Inpatient hospital coinsurance

• Emergency room fees

• Tiered drug costs

4. History of High Complaint Volume

CMS tracks plan-level complaint rates and plan performance. High numbers of complaints related to customer service, coverage denials, and billing disputes are strong indicators of trouble.

5. Frequent Changes in Networks or Benefits

If a plan has repeatedly changed its network or drastically revised its benefits over the past year, it could signal instability or poor management.

Why Some Enrollees Get Stuck in These Plans

Once you’re enrolled in a Medicare Advantage plan, changing it isn’t always straightforward. Outside of the Open Enrollment Period (October 15 to December 7), the only opportunity to switch is during the Medicare Advantage Open Enrollment Period (January 1 to March 31). During this time, you can switch to another Medicare Advantage plan or return to Original Medicare.

If you missed both windows, you must qualify for a Special Enrollment Period, triggered by specific life events such as moving or losing other coverage. This limited flexibility makes it even more important to avoid bad plans from the start.

Tips to Choose Better Options in 2025

You can protect yourself from the worst Medicare Advantage plans by following a few practical steps:

• Compare multiple plans using the official Medicare Plan Finder.

• Check the CMS star ratings for each plan.

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

• Ask about provider network size and availability.

• Verify if your current doctors and specialists are in-network.

• Examine drug formularies carefully to see what your medications will cost.

If you’re unsure, a licensed agent can help clarify these details and ensure you’re making an informed decision.

These Plans Often Look Appealing—Until You Need Real Care

In 2025, the worst Medicare Advantage plans continue to mislead people through superficial appeal. What seems like a convenient, all-in-one solution can quickly become a burden if you fall ill, need specialized care, or encounter billing disputes.

Don’t wait until you’re in the middle of a health crisis to realize your plan isn’t working for you. Make time to carefully compare plans, study the star ratings, and understand the full picture of coverage and costs. If you have questions, get in touch with a licensed agent listed on this website who can help you avoid the pitfalls and find a Medicare Advantage plan that actually supports your health needs.