Key Takeaways

• Low monthly premiums can hide high out-of-pocket expenses, strict authorizations, and limited coverage under some of the worst-rated Medicare Advantage plans.

• A plan’s star rating is a critical indicator of overall performance; choosing plans with consistently low star ratings can result in delayed or denied care.

Why Low Premiums Are Not the Whole Story

When you compare Medicare Advantage plans, it may be tempting to choose one with a lower monthly premium. On the surface, it looks like a smart way to save money. But what you may not realize until later is that those savings at the front end can turn into large and unexpected bills once you start using the plan.

Some of the worst Medicare Advantage plans in 2025 still offer low monthly premiums, which is part of why they continue to attract new enrollees. However, the savings often end there. These plans can come with limited networks, high cost-sharing, hidden restrictions, and administrative barriers that impact your ability to get the care you need.

Star Ratings Reveal the Bigger Picture

Medicare assigns star ratings to Advantage plans to measure their quality and performance. Ratings range from 1 to 5 stars, with 5 being excellent. Plans with fewer than 3 stars are considered low-performing. If you see a plan with a rating of 2.5 or below, that should raise a red flag.

Low-rated plans often:

• Have poor customer service

• Deny or delay needed services more frequently

• Show lower member satisfaction

• Offer fewer care coordination benefits

As of 2025, Medicare penalizes consistently low-rated plans, but that doesn’t mean such plans are off the market. Some still operate, often drawing attention with lower premiums despite their overall quality issues.

1. High Out-of-Pocket Costs Offset Premium Savings

While the monthly premium may be lower, the out-of-pocket costs for services can be significantly higher. Some of the worst Medicare Advantage plans:

• Require higher copayments for specialists, emergency care, or hospital stays

• Set high annual out-of-pocket maximums, sometimes up to $9,350 for in-network services in 2025

• Charge more for out-of-network services or deny them altogether

You might save $50 per month on premiums, but spend thousands annually on medical services.

2. Narrow Provider Networks Limit Access to Care

Low-performing Medicare Advantage plans often maintain very limited provider networks. That means you may not be able to see the doctors or specialists you prefer. Worse, you might have to travel longer distances to find a provider who is in-network.

You may also face challenges like:

• Frequent network changes during the plan year

• Loss of long-standing providers with no warning

• Denied referrals due to network constraints

This lack of continuity can disrupt treatment, particularly if you manage a chronic condition.

3. Prior Authorizations Create Unnecessary Barriers

Many of the worst Medicare Advantage plans rely heavily on prior authorization requirements. These are administrative approvals required before you can receive certain treatments, medications, or services.

In 2025, prior authorization continues to be one of the most commonly cited complaints among enrollees. Poorly rated plans may:

• Require authorization for routine or preventive care

• Take longer than average to process requests

• Deny services more often than higher-rated plans

This slows down access to care, delays treatment, and increases frustration.

4. Supplemental Benefits May Look Better Than They Are

Some of the most heavily marketed features of Medicare Advantage plans are the extra benefits, such as dental, vision, hearing, or fitness memberships. But in many low-rated plans, these benefits:

• Are severely limited in scope

• Come with hidden fees or provider restrictions

• Do not cover comprehensive care

For example, dental coverage might include only cleanings and one X-ray annually, with higher costs for crowns or root canals. Always review the benefit details closely rather than assume these extras will meet your needs.

5. Prescription Drug Coverage May Be Restrictive

Medicare Advantage plans usually include Part D prescription drug coverage, but not all coverage is equal. Some poorly rated plans in 2025 still have:

• Smaller formularies that exclude common medications

• Higher cost-sharing for brand-name drugs

• Complex tier structures that confuse consumers

Even with the 2025 $2,000 annual cap on Part D out-of-pocket drug spending, you can still face issues in reaching that cap if your medications aren’t covered, require step therapy, or are placed on a high-cost tier.

6. Customer Service Can Be a Repeated Source of Frustration

Star ratings account in part for customer service, and the worst plans often fall short. If a plan is hard to deal with when you have a question or problem, it can add stress and delay resolution.

Common issues include:

• Long call wait times

• Unhelpful or unclear answers

• Denied appeals with little explanation

• Billing errors or miscommunications

A poor support experience can turn even a small issue into a significant problem, especially when you need timely help.

7. Annual Plan Changes Can Make a Bad Plan Worse

Every fall, Medicare Advantage plans release an Annual Notice of Change (ANOC). Low-performing plans are known to make cost or coverage changes that further limit value without much warning.

These changes may include:

• Raising copays or coinsurance

• Dropping specific providers from the network

• Reducing coverage for certain services

If you don’t carefully review these changes during the Annual Enrollment Period (October 15 to December 7), you may end up with a plan that no longer suits your needs in the new year.

8. You Could Be Locked In When It Matters Most

You can only make changes to your Medicare Advantage plan during specific periods:

• Initial Enrollment Period (when you first qualify for Medicare)

• Annual Enrollment Period (October 15 to December 7)

• Medicare Advantage Open Enrollment Period (January 1 to March 31)

Outside of these windows, it’s very difficult to switch plans unless you qualify for a Special Enrollment Period. If you choose a low-quality plan and face issues mid-year, you may have to wait months before you can make a change.

9. Denials and Appeals May Be More Frequent

The worst plans often deny more services, which means you’ll spend more time and effort navigating the appeals process. In some cases, plans may:

• Use outdated criteria to justify denials

• Require multiple rounds of appeals

• Offer unclear instructions on how to appeal

This can lead to delays in treatment, especially for urgent health needs.

10. Star Ratings Matter More Than Ever in 2025

In 2025, CMS continues to rely on star ratings to assess Medicare Advantage plans. The rating includes over 40 measures across:

• Patient experience

• Managing chronic conditions

• Customer service

• Drug safety

Plans that consistently receive low scores may be flagged, but unless you review the star rating during enrollment, you might not realize a plan has serious issues until you’re enrolled.

If your plan has received under 3 stars for three consecutive years, CMS labels it as a low-performing plan. This should signal that it’s time to consider other options.

Choosing the Right Plan Starts with Asking the Right Questions

Avoiding the worst Medicare Advantage plans means doing your homework. Ask questions such as:

• What is the plan’s current star rating?

• What are the total out-of-pocket costs, not just the premium?

• How large and stable is the provider network?

• Are prior authorizations required, and how long do they take?

• What is the prescription drug coverage like?

• What does the fine print say about supplemental benefits?

When in doubt, speak with a licensed agent listed on this website who can explain the pros and cons of each plan in detail.

Avoid High Bills by Looking Beyond the Premium

The Medicare Advantage plan with the lowest monthly cost can seem attractive, but if that plan comes with high out-of-pocket limits, narrow networks, confusing drug coverage, or a track record of service denials, the costs will quickly add up.

Take the time to evaluate what you need today—and what you might need next year. Always review the plan’s star rating and benefit summary carefully. If anything seems unclear or too good to be true, it’s worth pausing to seek a second opinion.

For tailored help, get in touch with a licensed agent listed on this website who can review your options and help you choose a plan that meets both your health and financial needs.