Key Takeaways

• The best Medicare Advantage plans may not always be the best for you. Plan selection must be personalized based on your health needs, budget, and local provider network.

• Common missteps include focusing solely on CMS star ratings or low premiums while overlooking network restrictions, prior authorization rules, and annual changes to benefits.

What Medicare Advantage Plans Offer in 2025

Medicare Advantage (Part C) plans are offered as alternatives to Original Medicare. These plans bundle Medicare Part A (hospital insurance) and Part B (medical insurance) and often include additional benefits not found in Original Medicare.

In 2025, most Medicare Advantage plans include:

• Coverage for dental, vision, and hearing services

• Prescription drug coverage (integrated Part D)

• Annual out-of-pocket spending limits (unlike Original Medicare)

• Wellness programs or telehealth access

• Special Needs Plans (SNPs) for chronic conditions or dual eligibility

Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates these plans based on a 5-star rating system that considers customer service, care quality, complaints, and member experience.

Why Everyone Wants the Best Plan

It’s natural to aim for the best when it comes to your healthcare coverage. Many people begin their search looking for the highest-rated plan in their area or the one with the most benefits. But “best” is subjective in Medicare Advantage.

The best plan for you depends on:

• Your current and expected health conditions

• The doctors and hospitals you prefer

• How often you need care or prescriptions

• Your budget for premiums, deductibles, and copayments

High CMS star ratings indicate overall quality, but even a 5-star plan may not meet your personal needs if your preferred providers are out-of-network or if your medications are not on the formulary.

1. Mistake: Choosing Based Only on Star Ratings

While the CMS star rating is an important indicator of plan performance, it’s not the only factor you should consider. A 4- or 5-star plan may seem appealing, but these ratings reflect average experiences across all enrollees.

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

• Whether your doctor is in-network

• How much your specific prescriptions will cost

• The ease or difficulty of getting referrals and approvals

• Whether the dental or vision benefits are meaningful for your needs

Star ratings are a helpful reference point, but they should not be the sole deciding factor.

2. Mistake: Ignoring the Provider Network

Many Medicare Advantage plans are Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), which means they rely on provider networks.

If you choose a plan without confirming whether your doctors and specialists are in-network, you might face:

• Higher costs for out-of-network care

• Needing referrals for specialists

• Unexpected denials for services from non-participating providers

Even PPOs, which allow some out-of-network care, often charge significantly more for those services.

Always check:

• Primary care physician participation

• Specialist access

• Hospital affiliations

• Network changes year to year

3. Mistake: Overlooking Prescription Drug Coverage

Most Medicare Advantage plans in 2025 include Part D coverage. But formularies (lists of covered drugs) vary significantly between plans.

Failing to check your prescriptions could lead to:

• High out-of-pocket costs for non-covered drugs

• Restrictions like step therapy or prior authorization

• Tier placement that impacts your copayment

To avoid surprises, review:

• Whether your drugs are covered

• What tier they fall under

• If any restrictions apply

Also, pay attention to the plan’s pharmacy network. Preferred pharmacies usually offer lower copayments than standard ones.

4. Mistake: Focusing Only on Premiums

A lower monthly premium may look attractive at first glance, but it’s essential to assess the total cost of care.

In 2025, Medicare Advantage plans may have:

• Deductibles for medical and drug coverage

• Copayments for office visits, ER visits, and hospital stays

• Coinsurance for outpatient services or durable medical equipment

The real question is: how much will you pay throughout the year for your specific care needs?

Balancing monthly premiums with anticipated service costs is key. In some cases, a slightly higher premium plan with lower cost-sharing may be more cost-effective.

5. Mistake: Assuming Extra Benefits Are Always Worth It

Added perks like fitness memberships, dental cleanings, or over-the-counter (OTC) allowances can be useful. But these benefits vary widely in scope and usability.

Be cautious of marketing that promotes flashy benefits without clarifying the details:

• Are the dental benefits limited to cleanings or do they cover crowns and root canals?

• Does the vision benefit include progressive lenses or just basic frames?

• How much is the annual allowance for OTC products?

Focus first on core medical coverage, then evaluate how useful the extras will be in your specific situation.

6. Mistake: Forgetting About Prior Authorization

Many Medicare Advantage plans require prior authorization for services like:

• Imaging tests (MRIs, CT scans)

• Specialist visits

• Hospital admissions

• Durable medical equipment

While intended to control costs, prior authorization can delay care or lead to denial of services. Make sure to ask each plan:

• What services require prior approval?

• How long do authorizations take?

• What is the denial and appeal process?

This process may vary between plans, affecting how quickly you can receive necessary care.

7. Mistake: Not Reviewing the Annual Notice of Change (ANOC)

Every fall, plans send out the Annual Notice of Change, which outlines changes for the upcoming year. These changes may affect:

• Premiums

• Deductibles

• Copayments

• Covered drugs

• Provider networks

If you ignore the ANOC, you might be automatically re-enrolled in a plan that no longer suits your needs in 2025.

Always read your ANOC carefully between September and October, so you can make informed decisions during the Annual Enrollment Period from October 15 to December 7.

8. Mistake: Not Asking for Help

Medicare Advantage plans are complex. You’re not expected to understand every detail on your own. Trying to interpret formularies, provider directories, and cost comparisons by yourself can lead to confusion and poor choices.

In 2025, it’s easier than ever to get personalized help. You can:

• Call a licensed agent listed on this website

• Compare plans online

• Attend educational webinars or events

Getting professional assistance ensures your decision aligns with your unique healthcare needs and budget.

How Long Are You Locked into a Plan?

Once you enroll in a Medicare Advantage plan, you are usually committed to it for the calendar year, unless you qualify for a Special Enrollment Period.

The standard Medicare Advantage Open Enrollment Period runs from January 1 to March 31 each year. During this time, you can:

• Switch to another Medicare Advantage plan

• Drop your plan and return to Original Medicare

Outside of this window, changes are only allowed under special circumstances, such as moving to a new service area or losing other coverage.

What Happens If You Want to Switch Back?

Switching back from Medicare Advantage to Original Medicare can be tricky. If you had a Medigap (Medicare Supplement) policy before, you might not be guaranteed the same coverage again, depending on your state.

Most states only require guaranteed issue rights under certain conditions:

• Within the first 12 months of trying Medicare Advantage for the first time

• If your Medicare Advantage plan ends or you move out of the service area

Otherwise, you could be subject to medical underwriting, which may result in higher premiums or denial of coverage.

Why Annual Review Is Essential

Your health, medications, and finances may change year to year. Likewise, Medicare Advantage plans also change. That’s why reviewing your plan each fall is critical.

Ask yourself:

• Are my doctors still in the plan?

• Are my prescriptions still affordable?

• Have premiums or copays increased?

• Does the plan still fit my health priorities?

It’s not about loyalty to one plan; it’s about making sure your plan continues to meet your current needs.

Making the Best Choice Is Personal, Not Universal

The idea of “best” should reflect what’s best for you. Just because a plan is highly rated or popular doesn’t mean it’s the right fit.

In 2025, the variety and complexity of Medicare Advantage plans make it even more important to:

• Compare options carefully

• Understand your total costs

• Review networks and formularies

• Ask questions before enrolling

Take time to analyze not just what a plan offers, but what it means for your everyday healthcare.

Take the Next Step With Confidence

Finding the right Medicare Advantage plan is about aligning features with your needs. Avoid the common mistakes that so many make by reviewing all aspects of the plan—not just its surface features.

If you want help evaluating your options, speak with a licensed agent listed on this website. Their guidance can make the process faster, easier, and better aligned with your personal health and financial goals.