Key Takeaways

• Medicare Advantage plans with persistently low ratings and high complaint volumes can still be renewed each year due to regulatory loopholes, lack of consumer awareness, and limited oversight mechanisms.

• CMS star ratings, consumer complaints, and plan performance metrics should guide your decisions during Open Enrollment to avoid ending up in a poorly performing plan.

How Poor-Performing Medicare Advantage Plans Keep Slipping Through

If you’ve ever wondered why some of the worst Medicare Advantage plans are still offered year after year despite a trail of dissatisfied enrollees, you’re not alone. The reality is that these plans often remain in circulation due to a mix of regulatory complexities, marketing strategies, and consumer confusion.

CMS Star Ratings: What They Do and Don’t Do

Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage plans using a star rating system ranging from 1 to 5. This system is supposed to help you identify plans that perform well in terms of quality, customer service, and health outcomes.

• Plans rated 4 stars or higher are considered above average

• Plans rated below 3 stars are considered underperforming

Despite this, some 2-star or even 2.5-star plans continue to be offered year after year. This raises the question: why are these low-rated plans not discontinued?

1. Renewal by Default: CMS Regulations Allow It

Under current CMS regulations, Medicare Advantage plans are generally renewed automatically each year unless they are explicitly terminated. Even plans with poor performance metrics can continue to operate if they meet minimal compliance standards.

• CMS only mandates termination after three consecutive years with a star rating below 3.0

• Some plans avoid this by slightly improving ratings just enough to reset the three-year clock

As a result, plans that consistently receive complaints or underperform can remain on the market without significant intervention.

2. The Illusion of Choice During Open Enrollment

Every year from October 15 to December 7, you have the opportunity to change your Medicare coverage. While this should empower you to make better choices, the reality is more complicated.

• Many plans flood the market with marketing materials that highlight added perks while minimizing drawbacks

• Star ratings and complaint volumes are often buried deep in fine print or difficult to compare

This creates an environment where underperforming plans can thrive simply because they are better at marketing than at providing care.

3. Marketing Outpaces Oversight

One reason poorly rated plans continue to be renewed is aggressive marketing. These plans often target beneficiaries with ads highlighting benefits that sound appealing, such as dental or vision coverage.

However, what often goes unmentioned are the following:

• Narrow provider networks

• Prior authorization requirements

• Poor customer service

CMS regulates marketing, but enforcement remains inconsistent. Even when fines are issued, they often do not deter future violations. Plans continue to operate because the consequences are minimal compared to the profits they generate.

4. The Complaint System Is Not Always Transparent

Consumer complaints play a vital role in CMS evaluations, but the process is not as transparent as it should be. You may submit complaints through 1-800-MEDICARE or directly to CMS, but you often do not receive clear follow-up or public feedback.

• Complaints are aggregated but not always reflected clearly in public reports

• Star ratings may not fully account for systemic issues unless there is a pattern over time

In short, the system is reactive, not proactive. This allows plans with recurring issues to remain active.

5. Limited Local Options Reinforce Poor Choices

In some rural or underserved areas, you may have only a handful of Medicare Advantage plans to choose from. If a poorly rated plan is one of the few available, beneficiaries may feel they have no better option.

• Low competition in certain ZIP codes leads to less incentive for plans to improve

• This also limits your ability to switch to a higher-performing plan without changing your location

This geographic disadvantage means that some of the worst plans maintain enrollment numbers just by default.

6. Incentives to Stay: Locked-In Benefits Mask Problems

Some plans lure beneficiaries in with benefits that appear attractive, such as over-the-counter allowances or limited dental coverage. These extras may make you reluctant to switch plans, even if your care suffers.

• Once enrolled, you may only switch during specific periods unless you qualify for a Special Enrollment Period (SEP)

• Misleading advertising may suggest that switching will lead to losing core benefits, which is often not true

This inertia works in favor of underperforming plans, helping them retain members even when complaints are rising.

7. Data Lag and Rating Delays

CMS star ratings are based on data collected from prior years. That means the 2025 ratings, for example, largely reflect performance from 2023 and 2024.

• Ratings updates do not always reflect recent improvements or deteriorations

• This time lag allows poor performance to go unpunished for another year or more

This delay can mislead you into thinking a plan is stable when recent changes have significantly affected service quality.

8. Short-Term Fixes Delay Long-Term Accountability

Plans facing a drop below the 3-star threshold may make just enough improvements to avoid penalties. These may include:

• Temporarily expanding networks

• Increasing call center responsiveness

• Boosting member satisfaction through targeted surveys

However, these efforts may not be sustained beyond the period necessary to lift their ratings slightly. Once the threat of contract termination passes, many revert to previous operational standards.

9. You’re Not Always Comparing Apples to Apples

Medicare Advantage plans can differ significantly in cost structure, benefits, and provider access. Unfortunately, it’s not always easy to make direct comparisons across plans.

• Summary of Benefits documents are often overly complex

• Annual Notice of Change letters are long and confusing

Without clear guidance, you may find it hard to differentiate between a genuinely solid plan and one with a poor track record masked by flashy offerings.

10. The Burden of Research Falls on You

Despite all these systemic issues, you are expected to make informed decisions about your Medicare coverage every year. This can be overwhelming, especially given the amount of technical language and plan variations.

• CMS publishes the Medicare & You handbook, but it doesn’t contain plan-specific reviews

• Independent help is available, but many beneficiaries aren’t aware of these resources

As a result, many people simply stay with their current plan, even if it is underperforming.

Why This Matters More in 2025

In 2025, Medicare Advantage enrollment continues to rise, with more than half of all Medicare beneficiaries enrolled in a private plan. This makes the issue of poor-performing plans even more urgent.

• With such a large portion of the population enrolled, the impact of bad plans is magnified

• Delayed ratings, limited plan literacy, and persistent marketing gaps increase your risk of enrolling in a plan that doesn’t meet your needs

Awareness is no longer optional. It’s essential.

What You Can Do to Avoid These Traps

Avoiding the worst Medicare Advantage plans requires action during key decision periods and a willingness to dig beneath the surface. Here are a few strategies:

• Use the Medicare Plan Finder on Medicare.gov to compare CMS star ratings

• Call 1-800-MEDICARE for objective assistance with plan selection

• Review the Annual Notice of Change letter each fall to understand what is changing in your plan

• Speak to a licensed agent listed on this website who can walk you through the differences

Taking Control of Your Medicare Experience

The fact that low-rated Medicare Advantage plans continue to get renewed does not mean you have to settle for one. While the system is far from perfect, your best protection is informed decision-making. Recognize the warning signs: consistently low CMS ratings, high complaint rates, and vague benefit descriptions.

This Open Enrollment season, take the time to understand your options. Reach out to a licensed agent listed on this website to discuss your situation, compare plans, and ensure you are not among the many who unintentionally renew a plan that could fail you when it matters most.