Key Takeaways

• Medicare Advantage plans in 2025 often come with added perks like dental, vision, and fitness benefits, but these extras can obscure the plan’s core medical coverage and costs.

• CMS star ratings offer a useful performance benchmark, but they should not be your sole decision-making tool. What looks great on paper may not meet your personal health or financial needs.

Medicare Advantage Plans: More Than Meets the Eye

Medicare Advantage (Part C) plans promise a package of benefits that may look more attractive than Original Medicare. With additional services and a cap on annual out-of-pocket costs, it’s understandable why these plans are growing in popularity. In 2025, over half of all Medicare beneficiaries are enrolled in Medicare Advantage plans. But does more necessarily mean better for you?

To make an informed decision, you need to dig beneath the marketing. While perks like dental coverage or transportation services can be enticing, they are only part of the story. The core of your plan—how it covers hospital stays, specialist visits, prescription drugs, and chronic condition management—should be your primary focus.

What Makes a Medicare Advantage Plan “Best”?

In 2025, the Centers for Medicare & Medicaid Services (CMS) continue to use a star rating system to evaluate the quality and performance of Medicare Advantage plans. Plans are rated on a scale from 1 to 5 stars, with 5 indicating excellent quality.

Key factors CMS uses to assign these ratings include:

• Member experience and satisfaction

• Management of chronic conditions

• Preventive care services

• Customer service

• Medication safety and adherence

While a high star rating signals quality, it does not guarantee the plan will meet your personal needs. For example, a 5-star plan might have a narrow provider network or high drug costs in your area.

Common Features You’ll Find in Top-Rated Plans

Plans that receive high CMS ratings typically include:

• Coverage for prescription drugs (Part D)

• Annual maximum out-of-pocket limits

• Preventive services with low or no cost-sharing

• Access to telehealth services

• Supplemental benefits like dental, vision, hearing, and fitness programs

In 2025, many plans also continue offering services aimed at improving quality of life, including over-the-counter allowances and caregiver support programs. However, availability and quality of these benefits vary by location.

Extra Perks: Eye-Catching but Often Limited

Supplemental benefits can be valuable, especially if you need routine dental checkups or hearing aids. But it’s important to understand the limitations:

• Coverage caps: Dental and vision coverage may have annual spending limits.

• Network restrictions: You may be required to use specific providers.

• Availability: Some services may only be offered in select regions.

These extras should never be the main reason you choose a Medicare Advantage plan. Focus first on how the plan handles serious healthcare needs like hospitalizations, chronic condition management, and specialist access.

Out-of-Pocket Costs in 2025: Not Always Predictable

Medicare Advantage plans must set a limit on out-of-pocket spending for in-network services. In 2025, this maximum is $9,350 for in-network care and $14,000 for combined in- and out-of-network services. However, most plans set lower limits.

But here’s the catch:

• Copayments and coinsurance can still add up quickly, especially for hospital stays or high-cost imaging.

• Prescription drug costs vary by formulary and tier.

• Out-of-network charges can be substantial if your plan includes PPO features and you seek care outside the network.

While a plan may look budget-friendly on paper, your actual spending can be much higher depending on your healthcare needs.

Network Access: The Deal-Breaker for Many

One of the biggest distinctions between Medicare Advantage and Original Medicare is the use of provider networks.

• HMO plans require you to see providers within a specific network and get referrals for specialists.

• PPO plans offer more flexibility but still incentivize in-network use through lower cost-sharing.

In 2025, narrower networks are becoming more common. Before enrolling, confirm that your primary care provider, specialists, and preferred hospital are all in-network. Also, review the plan’s policies for emergency care and travel coverage.

Chronic Conditions and Complex Health Needs

If you live with diabetes, heart disease, cancer, or other chronic conditions, your plan’s ability to manage ongoing treatment is critical. Look for:

• Special Needs Plans (SNPs) if you qualify based on health or financial status

• Care coordination services

• Medication management programs

• Low-cost access to specialists

A general-purpose plan with great perks might not serve you as well as a lower-profile SNP that focuses on your specific diagnosis. In 2025, CMS continues to encourage plans to offer integrated services, but execution varies widely.

Prescription Drug Coverage in 2025

All Medicare Advantage plans that include Part D must follow CMS rules for:

• Drug formularies

• Tiered pricing systems

• Pharmacy networks

In 2025, the out-of-pocket cap for prescription drugs under Medicare Part D is $2,000. This is a significant change and applies even within Medicare Advantage plans that include drug coverage.

However, you should still review:

• Whether your medications are covered

• What tier they fall under

• If your preferred pharmacy is in-network

A plan might offer generic drug coverage at low cost, but brand-name or specialty drugs could still incur high out-of-pocket expenses.

Star Ratings and Plan Stability

Plans that earn consistent 4- or 5-star ratings may be more stable over time, with fewer mid-year changes to benefits or provider networks. However, CMS updates ratings annually, and your plan’s performance can decline in future years.

In addition to star ratings, look at:

• Member complaints and appeals

• Year-over-year premium and cost-sharing changes

• Customer service responsiveness

CMS also allows a one-time switch to a 5-star plan at any point in the year, offering flexibility if your current plan disappoints.

Enrollment and Timing in 2025

The Annual Enrollment Period (AEP) for Medicare Advantage runs from October 15 to December 7. Any changes made during this time take effect on January 1, 2026.

Other important periods include:

• Medicare Advantage Open Enrollment Period (January 1 to March 31): You can switch plans or return to Original Medicare.

• Special Enrollment Periods (SEPs): Triggered by events like moving, losing coverage, or qualifying for Extra Help.

Make sure to review the Annual Notice of Change (ANOC) each fall, which outlines how your plan’s benefits and costs will change in the coming year.

Evaluating Trade-Offs Before You Enroll

Not all trade-offs are obvious until you need care. As you evaluate your options in 2025, ask yourself:

• Will I have access to the doctors and hospitals I trust?

• Are my prescription drugs covered at a cost I can manage?

• What is my worst-case annual cost with this plan?

• Does the plan offer coordinated care for chronic conditions?

• Are the supplemental benefits actually useful to me?

It’s easy to get caught up in the appeal of added perks, but long-term peace of mind comes from knowing your essential medical needs are protected.

The Right Plan Depends on You, Not Just the Perks

The best Medicare Advantage plan for one person might be entirely wrong for another. While supplemental benefits may help you stay healthy and independent, they should never come at the cost of poor access, restrictive referrals, or high out-of-pocket costs when you need critical care.

Take your time to compare plans not just by perks or ratings, but by how well they match your medical, financial, and lifestyle needs.

Make a Smart Choice That Supports Your Health in 2025

Medicare Advantage plans in 2025 present an evolving landscape of benefits, costs, and care delivery. While they may seem more attractive than ever thanks to added perks and growing options, what matters most is how a plan supports your health and budget over time.

If you need help reviewing your choices or want expert insight into plan differences in your area, get in touch with a licensed agent listed on this website. They can help you understand which plan aligns best with your needs.