Key Takeaways

• Choosing the best Medicare Advantage plan in 2025 requires careful attention to plan details beyond the headlines, especially the limitations in coverage, network restrictions, and cost-sharing structures.

• CMS star ratings offer a useful starting point, but they do not guarantee that a highly rated plan is the right fit for your personal healthcare needs or financial situation.

What Medicare Advantage Plans Offer in 2025

Medicare Advantage (Part C) plans bundle hospital (Part A), medical (Part B), and often prescription drug (Part D) coverage into a single package. Most plans also include additional benefits such as dental, vision, hearing, fitness programs, and transportation services. These supplemental benefits appeal to many Medicare beneficiaries seeking convenience and potential savings.

In 2025, Medicare Advantage continues to grow in popularity. Many beneficiaries are drawn to the idea of combining multiple types of coverage under one umbrella. Yet, what makes a plan look good on paper may not always align with your real-world health needs.

CMS Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rate Medicare Advantage plans annually on a scale of 1 to 5 stars:

• 5 stars: Excellent

• 4 stars: Above average

• 3 stars: Average

• 2 stars: Below average

• 1 star: Poor

Ratings are based on factors such as customer service, care coordination, member experience, health outcomes, and patient safety. While helpful, these ratings are not personalized to your specific health situation or preferences.

Pitfalls That Lead to Picking the Wrong Plan

Understanding what can go wrong with Medicare Advantage selection helps you approach the decision with better clarity.

1. Overlooking Provider Network Restrictions

Many Medicare Advantage plans operate as HMOs or PPOs, which means they use provider networks. In HMOs, you typically must see in-network providers and get referrals for specialists. PPOs may allow more flexibility but often come with higher costs for out-of-network care.

Before enrolling, check:

• Whether your primary care doctor and specialists are in-network

• If your preferred hospitals are included

• Whether your nearest urgent care or emergency facility is covered

Skipping this step can leave you with a plan that severely limits your access to care.

2. Ignoring Out-of-Pocket Maximums

While Medicare Advantage plans have annual out-of-pocket limits for in-network care, these limits vary. In 2025, the maximum allowable out-of-pocket limit for in-network services is $9,350, and $14,000 for combined in-network and out-of-network expenses.

Some plans offer lower limits, but if you choose one with the highest thresholds, a major medical issue could mean significant financial strain.

3. Assuming Prescription Drugs Are Fully Covered

Most plans include Part D coverage, but not all cover every drug or dosage. Formularies (drug lists) vary widely, and tier structures can significantly impact what you pay at the pharmacy.

Make sure to:

• Check if your prescriptions are listed

• Confirm the tier each drug falls under

• Understand step therapy and prior authorization rules

Medicare Part D in 2025 introduces a $2,000 annual cap on out-of-pocket prescription drug costs, but that cap only applies once you reach the catastrophic phase. Some drugs may still have high initial costs.

4. Not Accounting for Supplemental Benefit Limits

Additional benefits like dental, vision, and hearing care can be attractive, but many plans place restrictions on what is covered.

For example:

• Dental coverage may include only cleanings and x-rays, not root canals or crowns

• Hearing aid coverage may have dollar limits or apply only to certain devices

• Vision care might include exams but not cover the full cost of eyeglasses

Review these benefits carefully before assuming they’ll save you money.

5. Relying on Advertising Instead of Research

Flashy ads may highlight convenient benefits or low monthly premiums, but they rarely mention:

• The cost of specialist visits

• Whether out-of-network care is covered

• Prior authorization requirements

• Service area limitations

Never make a decision based solely on TV or online promotions. They are designed to generate interest, not to explain the fine print.

What to Look For Instead

To avoid common mistakes, take a methodical approach when comparing plans.

1. Assess Your Healthcare Usage

Start with a realistic review of your health needs:

• How often do you visit doctors?

• Do you need specialists?

• What prescription medications do you take?

• Have you had any hospital stays or procedures recently?

Answering these questions can help you anticipate potential costs and services you’ll need covered.

2. Evaluate the Plan’s Network and Service Area

Confirm that the plan:

• Includes your doctors and facilities

• Covers your region or where you plan to travel frequently

• Offers adequate specialist access without excessive wait times

A large network is only helpful if it includes the providers you actually want to use.

3. Compare Costs Beyond the Premium

In 2025, monthly premiums vary widely among Medicare Advantage plans. But beyond the premium, also compare:

• Annual deductible (if any)

• Copayments for office visits and procedures

• Emergency room visit costs

• Coinsurance for hospital stays

• Maximum out-of-pocket limits

A plan with a low premium but high copays can cost more over the year than one with higher premiums and lower cost-sharing.

4. Investigate Drug Coverage Details

Don’t rely on assumptions. Use Medicare’s Plan Finder tool or contact a licensed agent listed on this website to:

• Search for your prescriptions

• View costs under each plan

• Identify whether step therapy or prior authorizations apply

Also verify whether the plan participates in the new Medicare Prescription Payment Plan, which allows you to spread out your drug costs over the year.

5. Understand Enrollment and Disenrollment Rules

You can enroll in or switch Medicare Advantage plans only during certain times:

• Initial Enrollment Period (IEP): 3 months before to 3 months after your 65th birthday month

• Annual Enrollment Period (AEP): October 15 to December 7 each year

• Medicare Advantage Open Enrollment: January 1 to March 31 (only for those already enrolled in a Medicare Advantage plan)

Outside these windows, changes require a qualifying life event.

If you choose a plan now and dislike it later, your ability to switch may be limited depending on timing and eligibility.

How CMS Star Ratings Fit In

While CMS ratings are a good quality marker, a 5-star plan may still be wrong for you if it:

• Lacks your doctors

• Doesn’t cover your medications adequately

• Includes high out-of-pocket costs

• Doesn’t meet your travel or specialist needs

Look at the star rating as a piece of the puzzle, not the whole picture.

Plans rated 5 stars may be eligible for a Special Enrollment Period, allowing you to switch anytime during the year. However, these plans are limited in availability and should still be assessed thoroughly.

Using Medicare Plan Finder and Additional Help

Medicare’s official Plan Finder tool allows you to:

• Compare multiple plans side by side

• Enter your specific medications

• Review provider networks

• Understand cost-sharing and coverage rules

For a more personalized experience, consult a licensed agent listed on this website. They can help interpret the fine print and ensure your plan selection aligns with your medical, financial, and lifestyle needs.

Your 2025 Medicare Advantage Decision Deserves Precision

The easiest plan to choose is often the most advertised, but rarely the most appropriate. Taking time to review provider access, prescription coverage, out-of-pocket limits, and benefit restrictions puts you in control.

Plans change annually, and even if you’ve had a Medicare Advantage plan before, 2025 may bring new benefits, updated networks, or modified cost structures. Do not auto-renew without reviewing these changes.

If you’re feeling overwhelmed or uncertain about what to do next, speak with a licensed agent listed on this website who can provide tailored support and guidance.