Key Takeaways

• Some of the worst Medicare Advantage plans appear most attractive during enrollment due to flashy marketing and seemingly low upfront costs, but they often carry hidden trade-offs that only surface once care is needed.

• Low star ratings, limited provider networks, and excessive prior authorization requirements are common traits of plans that underdeliver on actual care.

Why the Worst Plans Thrive During Enrollment Season

Every year, from October 15 to December 7, Medicare Open Enrollment puts dozens of plan options in front of you. This is the window when you’re encouraged to compare coverage, assess your current plan, and potentially switch to something better. Unfortunately, this is also when some of the most problematic Medicare Advantage (MA) plans get the most attention.

These plans often look great on paper. They may promote minimal monthly premiums, extra benefits like gym memberships, or access to vision and dental. But the problems emerge when you actually try to use the benefits you thought you were getting. Whether it’s restricted networks, denied prior authorizations, or burdensome copays, these plans can end up costing more in time, stress, and money.

What Makes a Medicare Advantage Plan One of the Worst

Some Medicare Advantage plans have recurring patterns that indicate lower quality and less satisfactory user experiences. Here’s what typically defines the worst plans:

Low Star Ratings

Medicare Advantage plans receive an annual star rating from the Centers for Medicare & Medicaid Services (CMS), ranging from 1 to 5 stars. A 5-star rating reflects excellent performance, while anything below 3 stars indicates poor service and low member satisfaction.

The worst MA plans consistently fall into the 2-star or even 1-star category. Low ratings often reflect issues such as:

• Poor customer service

• Delays in care coordination

• Frequent billing errors

• Denials or delays in access to needed treatments

• High rates of complaints and member disenrollment

In 2025, CMS continues to prioritize these ratings as a reflection of plan quality. If you come across a plan with less than 3 stars, proceed with caution.

Restrictive Provider Networks

One of the most common complaints about underperforming MA plans is that they rely on narrow provider networks. These plans often:

• Exclude top-rated hospitals or specialists

• Have limited access to in-network primary care physicians

• Frequently change participating providers, even mid-year

This can leave you scrambling for care, especially if your preferred doctor or hospital is suddenly out of network. Worse, switching providers may not be easy if you’re managing a chronic condition.

Prior Authorization Burdens

Another hallmark of poorly rated Medicare Advantage plans is an overreliance on prior authorizations. This means before you can get certain procedures, tests, or even prescriptions, the plan must approve it first.

These delays can cause serious disruptions in care. In 2024, CMS flagged prior authorizations as one of the top sources of complaints. For 2025, the agency has introduced tighter regulations, but not all plans are adapting well.

Signs of excessive prior authorization include:

• Requirements for basic diagnostic services

• Delayed approvals for time-sensitive procedures

• Denied claims for covered services

Misleading Marketing During Enrollment Season

During the annual enrollment period, marketing from MA plans is everywhere. Unfortunately, some of the worst plans use tactics that overpromise and underdeliver. Be especially cautious of:

• Mailers that emphasize supplemental benefits without details

• TV ads that gloss over limitations in coverage

• Aggressive sales calls that pressure you to switch plans quickly

Remember, any Medicare Advantage plan must provide all Part A and Part B services, but how and when you receive that care can vary drastically.

Why Low Premiums Shouldn’t Be Your Only Focus

While the idea of saving money upfront is appealing, the reality is that low monthly costs often come with higher out-of-pocket costs later. Many of the worst MA plans use this trade-off to hook you in:

• Higher copayments for hospital stays or specialist visits

• Increased coinsurance for outpatient procedures

• Steeper out-of-network charges or total exclusion of care outside the plan’s network

For example, a plan with a low monthly premium may still leave you paying thousands in copays if you require even a single inpatient admission.

What to Look for Instead

If you want to avoid getting stuck with a low-quality plan, take time to evaluate these key areas before making a decision:

1. Star Ratings (3 Stars or Higher)

Always check the plan’s most recent star rating. A plan with at least 3.5 stars has demonstrated solid performance. Anything below 3 stars should be a red flag.

2. Provider Network

Make sure your doctors and specialists are in-network. Contact their offices to confirm, as provider directories on plan websites are often outdated.

3. Prior Authorization Policies

Look through the plan’s summary of benefits and evidence of coverage. Check how often prior authorization is required. Plans with fewer requirements tend to be more user-friendly.

4. Maximum Out-of-Pocket (MOOP) Limit

In 2025, the MOOP limit for Medicare Advantage plans is $9,350 for in-network services and $14,000 for combined in- and out-of-network care. The worst plans often sit near these caps, meaning you could face significant expenses during the year.

5. Coverage of Chronic Conditions

If you have diabetes, heart disease, or other chronic conditions, evaluate how the plan supports ongoing care. Are there care coordinators? Are needed specialists included?

Common Signs a Plan May Disappoint You Later

Plans that overpromise often leave important information out of their brochures. Watch for these warning signs:

• Generic benefit language with few specifics

• Unclear copayment schedules

• Little or no explanation of specialist access

• Limited or no coverage for urgent care while traveling

These omissions can lead to costly surprises, especially when care is needed urgently.

Enrollment Periods Require Careful Comparison

Enrollment season can be overwhelming. You may receive dozens of plan offers, each promoting a different set of perks. But this is exactly when vigilance matters most.

Here’s how to compare plans effectively:

• Use the official Medicare Plan Finder at Medicare.gov

• Filter out plans below a 3-star rating

• Call your doctors to verify participation

• Check for prescription drug coverage tiers

• Review the annual Notice of Change from your current plan

If you’re unsure where to begin, this is the time to speak with someone who understands the fine print.

The Role of Star Ratings in 2025 and Beyond

Star ratings have a direct impact on your experience. In 2025, CMS places greater weight on metrics such as:

• Timeliness of care

• Medication adherence

• Member satisfaction

• Complaint rates

Plans that repeatedly fail to improve face reduced funding. While this may lead to improvement over time, poor-performing plans may still remain on the market.

If you’ve already enrolled in a low-rated plan and regret your choice, know that you may be eligible for a Special Enrollment Period (SEP) if your plan is flagged as consistently poor. SEP allows you to switch to a higher-rated plan outside the usual enrollment period.

Why the Worst Plans Still Exist

With all the oversight, you may wonder why these plans are still available. The answer lies in:

• Inconsistent enforcement of marketing rules

• Variability in regional plan offerings

• Lack of awareness among beneficiaries

Some people may simply not realize how their plan compares until they use it. Others may feel trapped because they missed the chance to review their options during open enrollment.

In many regions, the worst plans persist because they operate in areas with fewer alternatives or use aggressive outreach that clouds better options.

When Star Power Becomes a Smokescreen

It’s important to note that even star ratings aren’t foolproof. A 3-star plan may still carry limitations that affect you personally. For instance:

• Your medications may not be covered at favorable tiers

• Mental health providers may be absent from the network

• Copays for frequent visits could add up quickly

Always go a level deeper than the rating. What looks average overall might be below average for your unique health needs.

Making an Informed Choice This Year

2025 enrollment season continues through December 7. You have until that deadline to:

• Compare plan options

• Evaluate your current healthcare needs

• Verify all costs, including deductibles and copays

• Consider long-term health goals, not just short-term costs

It’s better to take time now than to spend the next year dealing with denied claims and inaccessible care.

Take the Next Step Toward the Right Plan

You deserve coverage that supports your health, not one that makes it harder to stay well. If you’re unsure about your choices or feel overwhelmed by the flood of options during this enrollment season, get in touch with a licensed agent listed on this website. They can help clarify your priorities, answer your questions, and guide you toward a plan that fits your needs without surprise costs or hidden restrictions.