Key Takeaways

• A low monthly premium does not guarantee long-term savings if your Medicare Advantage plan comes with high out-of-pocket costs, poor coverage, or limited provider access.

• Plans with a CMS Star Rating below 3 stars are consistently flagged for issues such as delayed care, poor member experience, and administrative complications.

Looks Can Be Deceiving: Why Some Plans Aren’t What They Seem

When you first compare Medicare Advantage plans, many may appear similar. They all promise coverage for hospital and medical services, some offer drug coverage, and many advertise extra perks. But not all plans are created equal, and some come with a hidden cost: stress.

Plans that seem appealing on paper often create ongoing frustration once you’re enrolled. You might face unexpected billing issues, coverage denials, or a lack of access to doctors in your area. These stressors can outweigh any savings you hoped to gain.

CMS Star Ratings: What They Really Tell You

Every year, the Centers for Medicare & Medicaid Services (CMS) assigns Star Ratings to Medicare Advantage plans, ranging from 1 to 5 stars. A plan with 4 or 5 stars is considered high-performing. But if a plan consistently scores below 3 stars, that’s a warning sign.

Low-rated plans may reflect:

• Poor customer service

• Difficulty accessing care

• High complaint rates

• Low member satisfaction

• Ineffective management of chronic conditions

As of 2025, CMS continues to make these ratings a cornerstone of its quality assurance system. Plans with fewer than 3 stars for 3 consecutive years may even face penalties or removal from the program.

Stressful Features to Watch Out For

Some plans generate more confusion, denial, and hassle than others. If you’re currently in the process of choosing or reviewing your Medicare Advantage coverage, beware of the following red flags.

Narrow Provider Networks

You might enroll in a plan thinking your doctor is covered, only to discover later that they are out of network. Some of the worst plans maintain extremely limited networks, requiring you to:

• Travel long distances to access care

• Switch providers frequently

• Get referrals for basic services

These hurdles create unnecessary stress, especially if you manage multiple conditions or have ongoing treatment needs.

High Out-of-Pocket Maximums

While Medicare Advantage plans must cap your annual out-of-pocket spending, the maximum can still be burdensome. For 2025, the in-network maximum is $9,350, and combined in- and out-of-network services can reach up to $14,000.

Plans with low premiums often shift costs into higher deductibles, copayments, and coinsurance. You may think you’re saving money until you experience a medical emergency or require ongoing care.

Prior Authorization Delays

The prior authorization process can delay or even block necessary treatments. Many lower-rated plans require pre-approval for a wide range of services, including:

• Advanced imaging (MRI, CT scans)

• Outpatient surgeries

• Skilled nursing care

This means your care could be postponed until the plan approves it, even if your provider already recommended it.

Inadequate Drug Formularies

Medicare Advantage plans include Part D prescription drug coverage, but each plan sets its own formulary. Poor-performing plans often:

• Cover fewer medications

• Require more step therapy or prior authorization

• Shift drugs to higher-cost tiers

These restrictions add stress when managing chronic illness or complex medication regimens.

Poor Member Experience and Support

CMS uses member experience data to score plans. If a plan receives consistent complaints from members, it will reflect in its rating. These issues often include:

• Long customer service hold times

• Poor claims resolution

• Inconsistent coverage explanations

If you find yourself confused, ignored, or stuck in a loop when trying to resolve a basic issue, your plan may be one of the problematic ones.

The Risk of Network Instability

Provider directories aren’t always accurate. You may find that the physician listed is no longer accepting your plan or has left the network. Worse, some plans update their networks frequently, forcing members to find new providers midyear.

This instability affects:

• Continuity of care

• Access to specialists

• Mental health treatment

These disruptions can impact your health and peace of mind.

Lack of Supplemental Benefits Where It Matters

Although some low-rated plans advertise extra perks like gym memberships or dental exams, they often fall short in delivering benefits that matter most. In many cases:

• Dental and vision coverage is minimal

• Over-the-counter allowances are restricted

• Transportation or caregiver support is unavailable

When these services are limited or unreliable, the burden shifts back to you, adding stress to your daily routine.

Enrollment and Disenrollment Challenges

Even getting into or out of a poorly rated plan can create stress. Beneficiaries often report trouble during:

• Annual Enrollment Period (October 15 to December 7)

• Special Enrollment Periods (triggered by life events)

Miscommunications, delays in enrollment processing, or unclear plan documents can leave you without coverage or with a plan you didn’t intend to select.

How CMS Penalizes Persistently Poor Plans

In 2025, CMS continues its approach of oversight for low-performing Medicare Advantage plans. If a plan receives fewer than 3 stars for 3 consecutive years, it may face:

• Reduced bonuses from CMS

• Removal from online comparison tools

• Contract termination in extreme cases

These penalties are intended to protect you, but the presence of such plans in the marketplace can still lead you astray if you rely on ads alone.

Advertising Doesn’t Equal Quality

One of the biggest dangers is assuming that a heavily advertised plan is automatically good. Many of the worst plans spend more on marketing than on improving member services. You might be swayed by:

• Promises of extra benefits

• Celebrity endorsements

• Mailers and cold calls

But none of these indicate actual plan quality. Only the CMS Star Rating and a thorough plan comparison reveal what you’re truly signing up for.

Hidden Administrative Burdens

Plans that look simple can turn complex when it’s time to use them. You might face:

• Difficult billing processes

• Rejected claims due to coding errors

• Denied appeals

These administrative hurdles cause time-consuming frustration, especially for older adults managing multiple health issues or caregiving responsibilities.

The Emotional Cost of Poor Plan Choice

Stress doesn’t just show up as frustration. A problematic Medicare Advantage plan can cause:

• Anxiety over medical bills

• Delayed care that worsens conditions

• Isolation if your doctor leaves the network

The emotional toll can be substantial, even if the monthly premium looks appealing. You may end up paying more through inconvenience, disruption, and worry than you would with a better-rated plan.

Annual Review: A Critical Step

Each fall, plans release their Annual Notice of Change (ANOC). This document outlines changes in coverage, costs, and benefits for the following year. In 2025, you should review this notice carefully before making a decision during the October 15 to December 7 enrollment window.

Signs that your current plan may be declining:

• Increase in out-of-pocket maximums

• New prior authorization requirements

• Reduced access to key specialists

If you notice these changes, it’s time to reevaluate your coverage.

Working With Someone Who Understands the Landscape

Choosing a Medicare Advantage plan is not a one-size-fits-all process. Even two plans in the same region with similar premiums can differ widely in:

• Provider access

• Drug coverage

• Supplemental benefits

A licensed agent listed on this website can help you compare your options based on your needs, not just the sales pitch.

The Real Cost Is Often in What You Can’t See

On the surface, a Medicare Advantage plan may seem like a smart way to reduce your monthly health costs. But when you look deeper, the true price may lie in limited care, long phone calls, and high stress levels.

Instead of focusing only on premiums or advertised perks, prioritize plans with:

• High CMS Star Ratings (4 or above)

• Reliable provider access

• Comprehensive formularies

• Transparent costs

Review your Annual Notice of Change, check your plan’s current rating, and reach out to a licensed agent listed on this website if you’re unsure about your current coverage.