Key Takeaways

• Medicare Advantage plans with low star ratings often bring frustrating delays, denials, and disruptions that interfere with timely, high-quality care.

• Even plans that appear affordable on the surface can leave you facing unexpected costs and limited provider access when it matters most.

The Warning Signs Are in the Star Ratings

Every year, the Centers for Medicare & Medicaid Services (CMS) assigns star ratings to Medicare Advantage plans, ranging from 1 to 5 stars. These ratings are based on how well plans perform in areas like member satisfaction, chronic condition management, preventative services, and customer service. In 2025, these ratings remain one of the few publicly available metrics to help you evaluate plan quality.

If you see a plan rated below 3 stars, proceed with extreme caution. These plans consistently underperform and often:

• Have poor customer service

• Delay or deny prior authorizations

• Fail to manage chronic conditions effectively

• Deliver lower member satisfaction

CMS issues penalties for consistently low-rated plans, including warnings or removal from the marketplace. Yet some of these plans remain available and attract unsuspecting enrollees based on flashy marketing or seemingly low out-of-pocket costs.

What the Worst Plans Tend to Have in Common

While every Medicare Advantage plan differs in structure, the worst-performing ones generally share the following features:

Poor Prior Authorization Policies

Many low-rated plans are notorious for excessive prior authorization requirements. These plans require you to get approval before receiving routine services, imaging tests, specialist referrals, or prescription medications. In 2025, prior authorization remains a key barrier to timely care.

Delays in these approvals can cause dangerous treatment interruptions. Worse, some plans issue outright denials that force you to pay out-of-pocket or skip care entirely.

Limited Provider Networks

Plans with small or unstable provider networks can leave you without access to the doctors and hospitals you prefer. You might be forced to travel far, wait longer for appointments, or see unfamiliar providers unfamiliar with your medical history.

Narrow networks are especially risky if you:

• Have multiple chronic conditions

• Need specialist access

• Live in rural or underserved areas

High Out-of-Pocket Expenses

While the worst plans often advertise low monthly premiums, they frequently make up the difference through high out-of-pocket costs. This includes:

• Steep copayments for specialists or hospital visits

• High deductibles before coverage kicks in

• Excessive cost-sharing for certain prescription drugs

In 2025, Medicare Advantage plans have a maximum out-of-pocket (MOOP) limit of $9,350 for in-network care. Poorly designed plans often push you toward that ceiling faster than you expect.

Unreliable Drug Coverage

Low-rated plans may offer barebones drug formularies. They often:

• Exclude commonly prescribed medications

• Move drugs to higher tiers with bigger copayments

• Change formularies midyear without clear communication

This can leave you scrambling to afford essential medications or switching prescriptions repeatedly.

Disorganized Customer Support

Poor communication is a hallmark of low-rated plans. Members often report:

• Long hold times

• Unhelpful representatives

• Repeated transfers without resolution

• Poor follow-up on appeals and grievances

If your plan can’t explain your benefits or fix issues in a timely way, it adds unnecessary stress to your healthcare experience.

Delays: When Timely Care Becomes a Waiting Game

You shouldn’t have to fight your insurance plan to access medically necessary care. Unfortunately, the worst Medicare Advantage plans are built around gatekeeping, not guidance.

In many of these plans, even routine care can take weeks to approve. This includes services like:

• Physical therapy

• Diagnostic scans

• Specialist consultations

Such delays are not just frustrating. They can worsen chronic conditions, increase the risk of complications, and force you into emergency care.

In 2025, CMS encourages plans to streamline prior authorizations, but compliance remains inconsistent. Plans with low star ratings are often the slowest to modernize these processes.

Denials: When Necessary Care Is Denied Completely

Some plans don’t just delay—they deny. In recent years, CMS and watchdog organizations found that certain Medicare Advantage plans issue inappropriate denials at a far higher rate than Traditional Medicare.

These denials most often target:

• Rehabilitation services

• Home health care

• Durable medical equipment (DME)

• Inpatient admissions

You have the right to appeal, but the burden falls on you. Many enrollees give up or accept lesser alternatives because the appeals process is confusing and slow.

If you’re dealing with a low-rated plan, expect to work harder to prove medical necessity, even when your doctors already have.

Disruptions: The Hidden Cost of Network Instability

Another major issue in low-quality Medicare Advantage plans is network instability. These plans often:

• Drop providers midyear

• Change contracts with hospitals without warning

• Misrepresent provider participation during enrollment

This results in disruptions that leave you scrambling for new doctors or navigating care transitions at the worst times.

In 2025, this issue continues to be one of the top complaints among Medicare Advantage members. When your cardiologist or oncologist suddenly goes out-of-network, it’s more than an inconvenience—it’s a disruption to your continuity of care.

Star Ratings Aren’t Perfect, But They’re a Useful Filter

It’s important to remember that CMS star ratings aren’t flawless, but they remain one of the best available tools for evaluating plans. Here’s how to use them wisely:

• Avoid plans rated below 3 stars, unless you’ve thoroughly reviewed them and have no better alternative.

• Compare plans rated 3.5 stars and above, as these tend to perform better on service delivery, access, and member satisfaction.

• Check for year-over-year consistency, since some plans spike their ratings temporarily with short-term fixes.

In 2025, CMS continues to make minor changes to the rating system, including new weightings for patient experience. Plans that ignore member feedback tend to fall in the rankings over time.

Why Some Low-Rated Plans Still Attract Enrollees

You might wonder why anyone enrolls in these poorly rated plans in the first place. Unfortunately, several factors work against informed decision-making:

• Aggressive marketing: Some plans invest heavily in promotional efforts while downplaying their star rating.

• Limited awareness: Many enrollees don’t check CMS star ratings or misunderstand what they measure.

• Appealing up-front costs: Low premiums and added benefits like dental or vision can overshadow more critical coverage issues.

• Language barriers and complexity: Understanding plan documents takes time and health literacy that not all beneficiaries have.

That’s why comparing beyond price and perks is essential. If a plan can’t deliver reliable care access, no add-on benefit is worth the tradeoff.

What You Can Do to Avoid a Bad Plan

You can take several steps during Medicare’s annual Open Enrollment period (October 15 to December 7) to protect yourself from the worst plans:

• Review CMS star ratings directly on the Medicare.gov Plan Finder.

• Compare out-of-pocket costs including copayments, coinsurance, and MOOP limits.

• Check provider directories and call doctors’ offices to confirm participation.

• Evaluate the drug formulary for your specific medications.

• Talk to a licensed agent who can explain the differences and help you avoid plans with red flags.

Also, use the Annual Notice of Change (ANOC) sent every September to see how your current plan is changing. Poor-performing plans often make cuts or raise costs that can go unnoticed until it’s too late.

How CMS Handles Poor-Performing Plans

CMS has tools to address persistently low-rated Medicare Advantage plans. In 2025, if a plan has received fewer than 3 stars for three consecutive years, CMS may:

• Remove the plan from the marketplace

• Prohibit new enrollments

• Issue formal warnings to current enrollees

While this regulatory oversight is improving, some low-quality plans still slip through. Until enforcement tightens, your best defense is careful review.

Don’t Let a Bad Plan Disrupt Your Care in 2025

Medicare Advantage can be a powerful option when done right. But the worst plans often look appealing until you need care. Delays, denials, and disruptions aren’t just inconveniences—they threaten your health, increase your stress, and often cost you more in the long run.

You deserve a plan that works for you, not against you. If you’re unsure whether your current plan is worth keeping or if you’re exploring options for the first time, speak with a licensed agent listed on this website. They can walk you through your choices, help interpret star ratings, and make sure you don’t end up in a plan that disappoints when you need it most.