Key Takeaways

• The worst Medicare Advantage plans often market themselves with flashy benefits, but they bury critical coverage restrictions in the fine print.

• Plans with consistently low star ratings, limited provider networks, and high out-of-pocket costs for essential services are common red flags to avoid.

The Allure of Too-Good-To-Be-True Medicare Advantage Plans

Each year during Medicare Open Enrollment (October 15 to December 7), you’re presented with dozens of options. Some Medicare Advantage plans seem to offer everything: bundled coverage, added perks, and seemingly low premiums. But in 2025, what looks like a good deal upfront may carry major consequences later.

The worst Medicare Advantage plans often count on your trust, distraction, or confusion. Their shiny perks and smooth language make it easy to overlook the details that matter most: access to care, claim denials, out-of-pocket expenses, and quality ratings.

What Defines a “Worst” Medicare Advantage Plan?

Medicare evaluates all Advantage plans each year on a 5-star scale. Plans rated 1 or 2 stars typically fall into the “worst” category. These low ratings reflect poor performance across:

• Member experience

• Timeliness of care

• Access to prescriptions

• Chronic condition management

Plans that consistently fail to meet minimum thresholds over multiple years may even be flagged by the Centers for Medicare & Medicaid Services (CMS), making them risky choices.

How Misleading Marketing Clouds Your Judgment

In 2025, marketing tactics have grown more aggressive. Many of the worst plans:

• Emphasize dental, vision, or grocery allowances while omitting coverage restrictions

• Downplay prior authorization requirements

• Use confusing or vague language about out-of-pocket maximums

• Send unsolicited mailers or cold calls to beneficiaries

You might feel enticed by these perks, but they’re often a tradeoff for limited coverage, restricted provider access, or high costs for complex medical needs.

Star Ratings: Your First Warning Sign

CMS star ratings remain one of the most transparent tools available to beneficiaries. Plans are rated annually, and poor performers are easy to spot:

• 5 stars = Excellent

• 4 stars = Above average

• 3 stars = Average

• 2 stars or below = Below average to poor

In 2025, any plan that continues to receive fewer than 3 stars for three consecutive years risks removal from the Medicare program. If you’re considering a plan with a 2-star rating or less, consider this a clear warning that members have reported major issues.

Network Restrictions That Limit Your Freedom

The worst Medicare Advantage plans typically operate with narrow networks. This may not seem like a big deal until you need to see a specialist or seek treatment from a top-rated hospital.

Plans with limited networks often:

• Force you to switch from your preferred primary care provider

• Exclude local specialists in cardiology, oncology, or orthopedics

• Require referrals for nearly every type of care

• Provide no out-of-network coverage (except for emergencies)

In 2025, many of the complaints filed with Medicare relate to network confusion or unexpected bills from out-of-network services. Make sure your current doctors are in-network before you enroll.

Prior Authorization: A Barrier You May Not Expect

Some of the worst plans require prior authorization for nearly every service beyond basic office visits. That includes:

• Imaging tests (like MRIs)

• Physical therapy

• Surgery

• Specialist consultations

• Durable medical equipment

Delays or denials in prior authorization can jeopardize your care. According to CMS audits from prior years, some plans even inappropriately denied necessary services. In 2025, while oversight has improved, some low-rated plans still misuse prior authorizations as a cost-control tool.

Out-of-Pocket Costs That Stack Up Quickly

Even if your monthly premium seems reasonable, the total cost of care can be surprisingly high. Look out for:

• High deductibles before coverage kicks in

• Expensive copays for specialist visits, hospital stays, or urgent care

• Coinsurance percentages instead of fixed copays

• Annual out-of-pocket limits that reach $9,000 or more for in-network care

In 2025, the Medicare Advantage in-network out-of-pocket maximum is capped at $9,350. Some of the worst plans hover close to this limit. Worse, they offer little value before you hit that cap.

Drug Coverage Gaps That Catch You Off Guard

Medicare Advantage plans that include Part D (prescription drug) coverage vary widely in what they offer. The worst plans tend to:

• Exclude commonly used brand-name drugs

• Have high-tier pricing with limited alternatives

• Impose step therapy before covering medications

• Apply a deductible close to the 2025 maximum of $590

Additionally, watch for narrow pharmacy networks. If your preferred pharmacy isn’t in-network, you could pay significantly more or be forced to switch.

Supplemental Benefits That Don’t Deliver

Medicare Advantage plans often highlight extras like transportation, over-the-counter (OTC) items, or fitness memberships. However, some low-rated plans:

• Require you to use only specific vendors or portals

• Offer benefits that are difficult to access

• Cap services at very low limits

For example, you might be allowed just one or two transportation trips per year or find that your OTC allowance only works at certain online retailers. In 2025, CMS requires plans to be more transparent about these limits, but poor communication still affects beneficiary satisfaction.

Poor Customer Service and Dispute Resolution

Low star ratings frequently reflect ongoing problems with member services. Some common issues in the worst plans include:

• Long wait times to reach a live representative

• Agents providing incorrect or conflicting information

• Slow resolution of coverage disputes

• Complicated appeals processes

These frustrations can be especially dangerous if you’re dealing with a new diagnosis or ongoing health issue and need help understanding your benefits.

Short-Term Gain, Long-Term Regret

The worst Medicare Advantage plans often perform well during the sales process. But by the time you realize how limited the coverage is, you may be locked in until the next Open Enrollment Period, unless you qualify for a Special Enrollment Period (SEP).

In 2025, most enrollees who select a plan during the fall Open Enrollment will have to remain with that plan from January 1 to December 31. Mid-year changes are allowed only under certain circumstances, such as:

• Moving out of the plan’s service area

• Losing other coverage

• The plan being terminated

• Qualifying for Extra Help or a special needs plan

Otherwise, if you enroll in a poor plan, you’re likely stuck with it for a full year.

Transparency Tools Can Help You Avoid a Bad Choice

CMS provides several tools to help you evaluate Medicare Advantage plans before enrolling:

• Medicare Plan Finder: Allows you to compare star ratings, cost estimates, and benefit details

• Annual Notice of Change (ANOC): Sent by your current plan each fall outlining upcoming changes

• Evidence of Coverage (EOC): A document listing what’s covered and what isn’t

Reviewing these carefully can help you catch hidden restrictions and compare plan quality objectively.

How to Choose a Plan That Truly Meets Your Needs

Instead of focusing on shiny perks, base your Medicare Advantage decision on the following factors:

• Provider Access: Are your doctors and hospitals in-network?

• Star Ratings: Does the plan score 3.5 stars or higher?

• Coverage Details: Are prior authorizations required? What services are excluded?

• Out-of-Pocket Costs: What is the annual limit? Are costs predictable?

• Drug Coverage: Are your prescriptions on the formulary and affordable?

• Customer Satisfaction: Are members happy with their service and support?

A good Medicare Advantage plan doesn’t just look good on paper. It needs to support your long-term health needs without unexpected limitations or costs.

Don’t Be Fooled by Empty Promises

Medicare Advantage can be a valuable option when the plan is high quality and matches your individual needs. But plans that seem too generous without fine print often disappoint when it matters most.

Instead of rushing your choice, take time to:

• Compare multiple plans using official tools

• Ask detailed questions about network access, prior authorizations, and pharmacy limitations

• Consider whether traditional Medicare with a Medigap policy might be more predictable

If you need help understanding the differences or choosing the right path, connect with a licensed agent listed on this website. They can walk you through your options based on your health priorities and financial situation.