Key Takeaways

• Even the best-rated Medicare Advantage plans in 2025 are not universally ideal; their value depends entirely on your health needs, location, and preferences.

• Features like low out-of-pocket maximums, extra benefits, and strong CMS ratings matter, but network restrictions and benefit changes must also be carefully evaluated.

What Makes a Medicare Advantage Plan “Best” in 2025

When you hear about the “best” Medicare Advantage plans, it’s important to understand that this label can mean very different things depending on who is using it. In 2025, the Centers for Medicare & Medicaid Services (CMS) continues to evaluate and rate Medicare Advantage plans on a 5-star scale, with 5 stars indicating excellent performance in areas like customer satisfaction, health outcomes, and access to care.

But the CMS rating is just one piece of the puzzle. A plan might have 5 stars but may not meet your needs if it doesn’t include your preferred doctors or cover the medications you take. High ratings indicate strong general performance, but not necessarily a good match for everyone.

Core Features That Define Strong Medicare Advantage Plans

Many of the top-rated plans in 2025 include similar core benefits, such as:

• Inclusion of Medicare Part A and Part B coverage

• Prescription drug coverage (Part D)

• Annual out-of-pocket maximum limits

• Routine dental, vision, and hearing services

• Wellness and fitness benefits

• Telehealth services

These features help enhance the standard Medicare package, but not all plans include them to the same extent. Additionally, even plans with similar benefits may differ in the fine print, such as how much you pay per visit, what counts toward your out-of-pocket limit, or whether a service is in-network.

Regional Differences Can Make or Break Your Choice

One of the most overlooked factors is geography. Medicare Advantage plans are offered on a county-by-county basis, which means the plan you saw advertised as one of the “best” may not even be available in your area.

Even when the same plan name appears across states or counties, the actual provider network, benefit structure, and copayment amounts can vary significantly. In some regions, a plan may offer a comprehensive dental package. In others, it may limit coverage to cleanings and exams only. If you split time between two states or travel frequently, this becomes even more critical.

CMS Star Ratings: Why They Matter but Don’t Say It All

The CMS star rating system plays a major role in helping you assess the overall quality of a Medicare Advantage plan. Plans are scored on a 1-to-5-star scale based on over 40 different metrics including:

• Preventive care delivery

• Chronic condition management

• Customer service

• Appeals and complaints handling

• Member experience surveys

Plans rated 4 stars and above are considered high-performing, and some incentives are tied to this rating. For instance, plans with 5 stars can be joined at any time during the year, not just during open enrollment. However, CMS ratings are based on performance from prior years, so a 2025 plan’s rating reflects 2023 or 2024 data.

Additionally, some plans may focus on metrics that improve ratings but don’t translate into a better experience for you. A plan may excel at managing diabetes outcomes but may have a narrow provider network or weak dental benefits.

Supplemental Benefits Are Expanding, but with Limits

In 2025, Medicare Advantage plans continue to expand the scope of their supplemental benefits. Many now include perks such as:

• Over-the-counter (OTC) allowances

• Transportation to medical appointments

• Meal delivery after hospital stays

• In-home support services

• Wellness programs

However, these benefits vary not just between plans but also by geographic location and plan structure. Some benefits may only be available to members with chronic conditions or under specific circumstances. Others may come with caps, such as limited number of rides per year or monthly OTC spending limits.

You should not assume that a benefit listed on a plan summary is automatically comprehensive. Always read the detailed plan documents or ask a licensed agent listed on this website for clarification.

Understanding the Cost Structure Beyond Premiums

In 2025, most discussions around Medicare Advantage plans still emphasize the monthly premiums. But premiums are just one part of the financial picture.

You also need to consider:

• Deductibles for medical and drug coverage

• Copayments and coinsurance for doctor visits, hospital stays, and specialist care

• Annual out-of-pocket maximums

• Costs for out-of-network services

The annual out-of-pocket limit in 2025 can go as high as $9,350 for in-network services and up to $14,000 when including out-of-network expenses. Once you hit that cap, the plan pays for covered services in full. But hitting that cap means you’ve already spent a substantial amount.

A plan with lower premiums may have higher coinsurance rates, while a plan with slightly higher premiums may limit your cost-sharing and offer more predictability.

Networks: The Hidden Dealbreaker

Every Medicare Advantage plan has its own network of providers. Some use Health Maintenance Organization (HMO) structures, which require you to use in-network providers and obtain referrals to see specialists. Others use Preferred Provider Organization (PPO) structures, which offer more flexibility but may charge more for out-of-network care.

Before choosing a plan, verify:

• Are your primary care provider and specialists in-network?

• Are nearby hospitals included in the plan network?

• Is there an adequate number of providers in your area?

If you frequently see specialists or are managing multiple conditions, limited networks can create major obstacles and unexpected costs.

Drug Coverage Gaps Can Be Costly

Most Medicare Advantage plans include Part D prescription drug coverage. In 2025, the Part D landscape sees a major shift with the $2,000 annual out-of-pocket cap fully implemented. This change helps limit your overall exposure to high drug costs, especially for brand-name medications or specialty drugs.

However, differences remain between plans in terms of:

• Covered drug formularies

• Prior authorization requirements

• Preferred pharmacies and mail-order options

A plan that covers your drugs now might change its formulary next year. That’s why you must review your plan’s Annual Notice of Change (ANOC) every fall to catch updates before Open Enrollment.

Open Enrollment Is Still Your Best Time to Switch

Medicare’s Annual Enrollment Period (October 15 to December 7) remains the best opportunity to:

• Switch between Medicare Advantage plans

• Move from Original Medicare to Medicare Advantage

• Return to Original Medicare with or without a Part D plan

Outside of this window, changes can typically only be made during Special Enrollment Periods triggered by life events such as moving or losing other coverage. A few exceptions exist, such as joining a 5-star plan, which can be done once per year outside the standard window.

Common Missteps When Choosing a Plan

Even with all the available tools, many people make decisions based on surface-level comparisons. Some common pitfalls to avoid include:

• Choosing based on name recognition instead of plan fit

• Overvaluing premium savings while underestimating out-of-pocket costs

• Assuming last year’s plan is still the best fit without reviewing changes

• Skipping drug formulary checks, especially if you take multiple prescriptions

• Not verifying provider participation in the current year’s network

By taking a more detailed look, you can avoid unpleasant surprises in the months ahead.

Matching the Plan to Your Real Needs

A plan might be rated 5 stars and include abundant extras, but that doesn’t mean it will meet your priorities. Your evaluation should include:

• Your preferred doctors and hospital affiliations

• Your chronic condition care requirements

• Your medication list and pharmacy preferences

• How often you travel or reside in multiple locations

• Your budget flexibility for unexpected medical expenses

Think of Medicare Advantage as a tailored suit. Even the finest fabric won’t fit right unless it’s cut to your measurements.

Why It’s Smart to Get Help from a Licensed Agent

Understanding all these factors can be overwhelming, especially as plan details evolve every year. That’s why talking with a licensed agent listed on this website can help. They can:

• Compare plans available in your ZIP code

• Evaluate provider networks and coverage gaps

• Confirm drug coverage specifics and cost-sharing

• Clarify recent plan changes and benefits

Licensed agents have access to plan details beyond what public plan finders display. Their insights can save you time, money, and frustration when making a choice for 2025.

Finding the Right Fit in 2025 Is Worth the Extra Time

Medicare Advantage plans in 2025 continue to evolve with new rules, expanded benefits, and changing networks. While some are truly excellent in terms of coverage and service, that excellence is only meaningful if it matches your personal circumstances.

Taking the time to look past the headline features and evaluate your actual needs ensures you select a plan that works for you. Don’t rush the process. Compare plans thoroughly. Talk to a licensed agent listed on this website for advice that reflects your local options and medical profile.