Key Takeaways

• Many people are reconsidering their Medicare Advantage plan choices in 2025 due to unexpected costs, limited networks, and changing benefits.

• CMS star ratings are useful but should not be the only factor you rely on when comparing plans.

The Allure of Medicare Advantage Plans

Medicare Advantage plans continue to attract millions of enrollees each year. Offered by private insurance companies approved by Medicare, these plans bundle together hospital (Part A), medical (Part B), and usually prescription drug (Part D) coverage. Most include extra benefits not found in Original Medicare, such as:

• Dental, vision, and hearing coverage

• Wellness programs

• Transportation to medical appointments

• Over-the-counter medication allowances

These perks can seem like a complete package. However, as 2025 progresses, many enrollees are realizing that choosing the best-rated or most popular plan doesn’t always translate into the best experience or value.

Why Satisfaction Is Slipping in 2025

While enrollment in Medicare Advantage plans continues to grow, dissatisfaction is also becoming more common. Enrollees are encountering issues they may not have anticipated when they first joined their plan.

1. Unexpected Out-of-Pocket Costs

Even though many plans advertise low premiums or copays, 2025 continues to reveal how quickly costs can add up. These may include:

• Copayments for specialist visits ranging from $30 to $60

• Coinsurance for hospital stays or outpatient procedures

• Higher costs for out-of-network care or referrals

• Prescription drug cost-sharing despite annual caps

Many plans have a maximum out-of-pocket (MOOP) limit for in-network services, which in 2025 is $9,350. However, this doesn’t mean your costs will be predictable. If you need frequent care or high-cost prescriptions, you may reach this ceiling faster than expected.

2. Narrow or Changing Provider Networks

A significant concern in 2025 is the limited or shifting nature of provider networks. You may have signed up for a plan because your doctor was listed as in-network, only to find out during the year that the provider is no longer part of the plan. This can result in:

• Needing to switch doctors

• Losing access to preferred hospitals or specialists

• Delays in treatment due to required referrals

What makes this more frustrating is that plans are allowed to change their networks at any time, not just during open enrollment.

3. Prescription Drug Surprises

Even though Medicare Advantage plans often include Part D coverage, the costs and coverage details vary widely. In 2025, while there is a new $2,000 annual cap on out-of-pocket drug expenses under Part D, you can still encounter:

• Formulary restrictions

• Prior authorizations

• Step therapy requirements

Many enrollees are discovering that not all medications are covered, or that preferred pharmacies change, making their medications more expensive mid-year.

4. Limitations of Extra Benefits

Plans often advertise dental, vision, and hearing benefits, but in 2025, many people are finding that these extras come with limitations, such as:

• Yearly dollar caps on coverage (e.g., $500 or $1,000)

• Limited provider networks

• Long wait times for appointments

These benefits sound attractive but can feel disappointing if you’re unable to use them when you need them most.

What the CMS Star Rating Really Means

The Centers for Medicare & Medicaid Services (CMS) issues star ratings to Medicare Advantage plans each year, ranging from 1 to 5 stars. In 2025, these ratings are based on more than 40 performance measures, including:

• Customer service

• Managing chronic conditions

• Member complaints and disenrollment

• Preventive care

• Medication adherence

Plans with 4 stars or more are considered high-quality, but this does not guarantee a plan will suit your needs. A 5-star plan may excel in preventive services but could have a narrow network or strict rules for prescriptions.

In 2025, over 50% of plans hold 4-star ratings or higher, but star ratings alone can’t tell you if your doctors are in-network or if your medications are covered affordably.

Reviewing Your Plan Annually Is More Important Than Ever

Each fall, you receive an Annual Notice of Change (ANOC) from your plan. It outlines any updates to:

• Premiums and copays

• Provider networks

• Drug formularies

• Coverage rules and benefits

In 2025, many enrollees who skipped reviewing this document in 2024 are facing surprise costs. This underscores the need to compare your current plan with others during the Medicare Open Enrollment Period, which runs from October 15 to December 7 every year.

Medicare Advantage vs. Original Medicare in 2025

Some beneficiaries are now reassessing whether staying in Medicare Advantage is right for them. The decision between Original Medicare and Medicare Advantage hinges on what matters most to you:

Original Medicare + Medigap (Supplement)

• Nationwide access to any provider who accepts Medicare

• Freedom to see specialists without referrals

• Medigap policies help cover out-of-pocket costs

• You must buy Part D separately

Medicare Advantage

• Lower monthly costs in some cases

• Extra benefits like dental and vision

• Care is limited to local networks and may require referrals

• Cost-sharing varies by service and plan

If you travel frequently or want the flexibility to see any doctor, Original Medicare with a Medigap policy may be worth considering, despite its higher monthly premium. If local care and built-in perks are more appealing, Medicare Advantage might suit you—provided you thoroughly research the plan.

Enrollment Windows You Should Know

In 2025, you can only change your Medicare Advantage plan during specific periods:

• Initial Enrollment Period (IEP): When you first become eligible (7 months around your 65th birthday)

• Medicare Open Enrollment (Oct 15 to Dec 7): Switch, join, or drop a plan for the following year

• Medicare Advantage Open Enrollment (Jan 1 to Mar 31): Switch to another Medicare Advantage plan or return to Original Medicare (only one change allowed)

Missing these windows could lock you into a plan you’re unhappy with for the rest of the year.

How to Compare Plans Effectively in 2025

It’s no longer enough to go by the plan’s CMS rating or advertised perks. Use the following strategies when evaluating your options:

• Check provider directories to confirm your doctors and hospitals are in-network

• Review drug formularies to ensure your prescriptions are covered affordably

• Compare cost-sharing for services you use often, including specialist visits, diagnostic tests, and therapies

• Assess out-of-pocket maximums and how quickly you might reach them

• Look at member satisfaction trends to see if current enrollees are reporting problems

Also, consider contacting a licensed agent listed on this website to help interpret the details and align plan choices with your specific needs.

What’s Driving the Shift in 2025

Several factors are contributing to why more people are rethinking their Medicare Advantage choices this year:

• Aging population: With more seniors managing multiple conditions, plan limitations are harder to overlook

• Greater awareness: After years of aggressive marketing, more enrollees are now digging deeper into plan specifics

• CMS transparency: In 2025, CMS has expanded consumer access to comparative plan tools, which make shortcomings easier to spot

• Healthcare inflation: Rising service costs are exposing how much you can actually pay under a plan with coinsurance

These realities are prompting beneficiaries to re-evaluate what matters most: predictable costs, provider access, and comprehensive coverage.

Taking the Time to Choose Wisely Pays Off

The Medicare landscape in 2025 remains complex, and what may appear to be the “best” Medicare Advantage plan might not be the right one for your needs. It’s essential to invest time reviewing plan documents, asking questions, and comparing benefits thoroughly.

Skipping these steps can result in:

• Limited access to care

• High annual expenses

• Missed prescription drug coverage

• Loss of trusted healthcare providers

You should never feel rushed or pressured. Take advantage of available resources and schedule a conversation with a licensed agent listed on this website to help evaluate your current plan or explore alternatives.

Rethinking Your Medicare Advantage Plan Is a Smart Move in 2025

As more people discover gaps in their Medicare Advantage coverage, it’s clear that staying informed and reviewing your options annually is no longer optional. Don’t rely solely on perks, star ratings, or last year’s satisfaction. Your health needs, prescriptions, and preferred providers may have changed. So might your plan.

Before the next enrollment window closes, take time to verify that your plan still meets your goals. If it doesn’t, explore others with help from a licensed agent listed on this website.