Key Takeaways

• The best Medicare Advantage plans in 2025 often advertise strong benefits and low out-of-pocket costs, but not all perks are guaranteed to fit your healthcare needs or lifestyle.

• CMS star ratings offer helpful insight into plan quality, but you need to go beyond the ratings to fully understand provider networks, out-of-pocket limits, and coverage restrictions.

Understanding the Basics of Medicare Advantage Plans

Medicare Advantage (Part C) plans are private alternatives to Original Medicare. These plans are approved by the Centers for Medicare & Medicaid Services (CMS) and must cover everything Original Medicare does, including Part A (hospital) and Part B (medical). Many also include Part D (prescription drug coverage) and offer additional benefits like dental, vision, hearing, and wellness services.

In 2025, most Medicare Advantage plans bundle multiple services into one plan, aiming to make your healthcare coverage more manageable. However, the trade-off is often less flexibility in choosing providers and potential limitations on coverage if you travel or live in multiple states throughout the year.

What Makes Medicare Advantage Plans Stand Out

Extra Benefits

Many of the top-rated Medicare Advantage plans promote perks not covered by Original Medicare, such as:

• Dental cleanings and restorative procedures

• Routine vision exams and eyewear allowances

• Hearing aids and audiologist visits

• Fitness programs and wellness incentives

• Telehealth services

These extras can make a plan look highly attractive, especially if you anticipate using those services. But it’s important to review how these benefits are structured, whether they’re included automatically, or if they come through optional supplemental packages with separate costs.

Prescription Drug Coverage

Most Medicare Advantage plans include Part D coverage. However, formularies (the list of covered medications) can differ significantly. In 2025, CMS requires plans to offer at least a standard level of prescription drug coverage, but:

• Drug tiers vary by plan and affect your cost-sharing

• Prior authorization or step therapy may apply

• Preferred pharmacies can lower your copays, but they may be limited

Make sure your medications are covered in the plan’s formulary and at a cost you find reasonable.

Out-of-Pocket Maximums

Unlike Original Medicare, Medicare Advantage plans must include a yearly limit on out-of-pocket costs for Part A and B services. In 2025, the maximum for in-network services is $9,350. Plans may offer lower thresholds, which can be beneficial if you require frequent care. However:

• Prescription drug costs are not included in this maximum

• If your plan includes out-of-network coverage, those expenses may be capped separately or not at all

How CMS Star Ratings Help—and When They Don’t

Each year, CMS evaluates Medicare Advantage plans using a 5-star system. Ratings are based on factors like:

• Preventive care and chronic condition management

• Member experience and satisfaction

• Complaints and member disenrollment

• Call center responsiveness

• Drug safety and accuracy of pricing

Plans with 4 or more stars are generally considered high quality. For 2025, these ratings continue to influence enrollment. Still, star ratings are not the full story. A 5-star plan in your area might:

• Have limited network access

• Exclude specific doctors or hospitals you prefer

• Place your medications in higher cost-sharing tiers

Use the rating as a quality benchmark, but always examine the plan’s full benefit structure before enrolling.

What’s Often Overlooked in Popular Plans

Network Limitations

Most Medicare Advantage plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). While PPOs offer slightly more flexibility, both rely on network participation. Common restrictions include:

• Needing referrals to see specialists

• Higher costs for out-of-network providers

• Limited geographic availability

If you travel frequently or live in more than one state during the year, this can become a problem. Even telehealth may be restricted to in-network providers depending on the plan.

Prior Authorization Requirements

Many services under Medicare Advantage plans require prior approval. This includes:

• Diagnostic tests

• Durable medical equipment

• Physical therapy

• Inpatient admissions

These requirements can delay care or add administrative burdens. Even top-rated plans may enforce prior authorizations to manage costs.

Plan Changes Every Year

Each fall, Medicare Advantage enrollees receive an Annual Notice of Change (ANOC) letter. It outlines modifications effective January 1. These can include:

• Changes in premiums and cost-sharing

• Provider network adjustments

• Drug formulary updates

• Altered benefit structures

You should never assume your current plan will stay the same in the following year. Comparing your plan against others during the Medicare Open Enrollment Period (October 15 to December 7) is essential.

Evaluating a Plan for Your Situation

The most popular Medicare Advantage plan in your area might not be the best one for you. To make a suitable choice, consider the following:

Your Providers

• Are your current doctors and specialists in the plan’s network?

• Does the plan require referrals?

• Are your preferred hospitals covered?

Your Medications

• Are your drugs on the plan’s formulary?

• What are the copays for your drug tiers?

• Are you required to use preferred pharmacies?

Your Budget

• What is the monthly premium (if any)?

• How much will you pay for doctor visits, hospital stays, and specialist care?

• What is the out-of-pocket maximum?

Your Lifestyle

• Do you travel or live part of the year in a different state?

• Do you need out-of-network access?

• Are additional benefits, like gym memberships or dental coverage, a priority?

Making Sense of the Enrollment Timeline

In 2025, the key Medicare enrollment periods remain the same:

• Initial Enrollment Period (IEP): Starts 3 months before your 65th birthday, includes the month of your birthday, and ends 3 months after.

• Annual Enrollment Period (AEP): From October 15 to December 7 each year, you can switch plans or return to Original Medicare.

• Medicare Advantage Open Enrollment Period: From January 1 to March 31, allows one change if you’re already enrolled in a Medicare Advantage plan.

Outside these windows, you may qualify for a Special Enrollment Period due to events like moving, losing employer coverage, or eligibility for Medicaid.

Why Bigger Isn’t Always Better

Plans with the largest membership or highest star ratings often dominate advertising during open enrollment. However, that doesn’t mean they’re a universal fit. Bigger plans may offer broad networks in metropolitan areas but limited access in rural regions. Or they might include many benefits you’ll never use, while skimping on the ones that matter most to you.

In some cases, smaller regional plans offer better local service, more targeted provider networks, or stronger support for chronic conditions. Reviewing each plan with your unique healthcare profile in mind will give you the best outcome.

Why CMS Ratings Shouldn’t Be Your Only Filter

While the CMS star rating is a trusted indicator of performance, it should be only one part of your decision-making process. Ratings don’t capture whether a plan suits your personal circumstances. A 4-star plan might offer low copays and excellent service but have no providers near you. Another may have strong customer support but limited drug coverage.

What matters most is how a plan fits your health conditions, prescription needs, and financial situation—not how well it performs in generalized national surveys.

Getting Help From a Trusted Source

Medicare Advantage plans are not one-size-fits-all. Even the most appealing plan on paper can be a poor fit depending on your specific situation. That’s why speaking with a professional can be so helpful.

If you’re feeling uncertain about comparing coverage, provider access, or drug formularies, consider reaching out to a licensed agent listed on this website. They can provide personalized guidance based on your health needs, budget, and location.

Review All the Factors Before You Enroll

The best Medicare Advantage plans in 2025 may offer a strong package of benefits, but the real value depends on how well they align with your healthcare needs. You should carefully examine network restrictions, prior authorizations, annual changes, and actual out-of-pocket spending. Relying only on the star rating or the list of extra perks can be misleading.

If you need help reviewing your options, get in touch with a licensed agent listed on this website. They can walk you through the plan details and help ensure your choice supports your long-term health and financial goals.