Key Takeaways
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Medicare Advantage plans offer attractive features, but the fine print often hides network restrictions, referral rules, and unexpected out-of-pocket costs that vary widely by plan.
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A high CMS star rating can indicate plan quality, but it doesn’t guarantee the plan will meet your individual health or travel needs.
The Allure of the Best Medicare Advantage Plans
At first glance, the best Medicare Advantage plans in 2025 appear to check every box. They include hospital and medical coverage, and many also offer prescription drug benefits. Beyond that, you’ll often see added perks like dental, vision, hearing, and fitness memberships. These features sound like a win-win, especially when plans are labeled with high star ratings from the Centers for Medicare & Medicaid Services (CMS).
CMS uses a 5-star system to evaluate Medicare Advantage plans based on factors like customer service, member experience, and healthcare outcomes. A 4-star or 5-star rating may look like a seal of approval. However, a high rating doesn’t necessarily mean the plan works for your unique needs, especially if you frequently travel, need specialized care, or manage multiple chronic conditions.
What CMS Star Ratings Do—and Don’t—Tell You
CMS star ratings reflect how well a plan performs across specific metrics. These include:
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Chronic condition management
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Preventive services
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Member complaints and appeals
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Customer service
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Pharmacy services (for plans that include drug coverage)
While helpful for identifying overall performance, these ratings do not account for localized factors such as:
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Network size and provider availability in your area
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Restrictions on seeing out-of-network doctors
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Prior authorization rules for diagnostic or specialist services
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Actual out-of-pocket costs for the services you use most
This means a 5-star plan in theory may not serve you well in practice if your preferred doctors aren’t included or if you face referral barriers every time you need specialist care.
Network Restrictions Still Limit Your Options
One of the most common surprises people face is discovering how limited the provider network can be. Many of the best-rated Medicare Advantage plans are Health Maintenance Organizations (HMOs), which typically require you to use a set group of doctors and hospitals. Referrals from your primary care physician are often needed for specialist visits.
Even Preferred Provider Organizations (PPOs), which offer more flexibility, still favor in-network care. Out-of-network care may be covered at a higher cost or not at all, depending on the service. That can be a critical issue if you need care while traveling or if your preferred specialists aren’t part of the plan’s network.
Not All Extra Benefits Are Created Equal
Supplemental benefits like dental, vision, and hearing can add appeal to Medicare Advantage plans, but the scope and quality of these benefits vary greatly. In 2025, most plans offer at least some of these services, yet the limits can be tight.
For example:
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Dental coverage may only include cleanings and x-rays, with caps on more extensive procedures.
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Vision benefits might cover an annual exam but offer little toward glasses or contact lenses.
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Hearing aid benefits could have limited dollar amounts, requiring substantial out-of-pocket contributions.
Be sure to review what these extras really include. Don’t assume that all services will be fully covered or that they match your needs.
Out-of-Pocket Costs Can Still Be Significant
Although Medicare Advantage plans are required to cap your annual out-of-pocket spending for in-network services, the actual ceiling can be high. In 2025, the maximum out-of-pocket limit for in-network care is $9,350, with combined in- and out-of-network limits reaching up to $14,000 in some cases.
Plans with lower premiums may have higher deductibles, copayments, or coinsurance rates. Keep in mind that:
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Hospital stays often carry daily copayments
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Specialist visits can range from $30 to $60 or more per visit
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Emergency room care typically costs between $100 and $150
These costs add up quickly, especially if you have a chronic condition or multiple doctor visits in a year. Review the plan’s Summary of Benefits closely, not just its promotional highlights.
Prescription Coverage Has Changed in 2025
Medicare Advantage plans that include Part D prescription drug coverage now must follow the new 2025 rules:
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A $2,000 annual out-of-pocket cap for covered prescriptions
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Elimination of the former donut hole coverage gap
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Option to spread drug costs over monthly payments through the Medicare Prescription Payment Plan
While these changes make drug coverage more predictable, plans still vary in terms of formularies, prior authorization, and preferred pharmacy networks. Your out-of-pocket costs can differ depending on the medications you take and where you fill your prescriptions.
Referrals and Prior Authorization Rules Still Apply
Medicare Advantage plans commonly use prior authorization to control costs. This means your doctor may need to get the plan’s approval before you can access certain services, including:
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MRIs and CT scans
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Inpatient hospital stays
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Durable medical equipment
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Some specialty prescriptions
In 2025, efforts to streamline this process have improved transparency, but it remains a burden for many patients. Delays or denials can still occur, especially with complex or expensive care.
Travel May Complicate Your Coverage
If you travel frequently, Medicare Advantage plans can be problematic. Most plans are designed to provide coverage within a specific geographic area. Even PPOs, which allow some out-of-network coverage, may still charge more when you’re away from your primary service area.
Plans may only cover emergency or urgent care when you’re outside your coverage region. Routine care, even for existing conditions, may not be reimbursed. If you split your time between states or live in a different region during parts of the year, this is a critical factor to consider.
Special Needs Plans Aren’t for Everyone
Some of the highest-rated Medicare Advantage plans in 2025 are Special Needs Plans (SNPs). These are tailored for specific populations, including:
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People with chronic conditions
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Dual-eligible individuals (Medicare and Medicaid)
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Residents of long-term care facilities
While SNPs can provide highly targeted care, they are only available if you meet the specific eligibility criteria. They’re not open to the general Medicare population, even if the benefits appear attractive.
Switching Plans Isn’t Always Easy
Once you enroll in a Medicare Advantage plan, your ability to change plans is limited to certain times of year:
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Annual Enrollment Period: October 15 to December 7
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Medicare Advantage Open Enrollment Period: January 1 to March 31 (only for current Medicare Advantage enrollees)
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Special Enrollment Periods: Triggered by qualifying life events (such as moving or losing other coverage)
Even if you realize the plan doesn’t meet your needs, you may be locked in until the next enrollment period. That’s why it’s important to do your research upfront.
Your Needs May Not Match the “Best” Plan
What works for one person may not work for another. A plan with a 5-star rating may offer excellent preventive care, but if you need frequent specialist visits, want broader travel coverage, or take brand-name medications, it may fall short.
Personal factors to consider include:
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Your health conditions and expected services
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The doctors and hospitals you prefer
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Prescription medications you rely on
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Whether you live in one place year-round
The best plan isn’t the one with the flashiest extras or the highest rating. It’s the one that aligns with your lifestyle and healthcare needs.
Evaluating Medicare Advantage Plans in 2025
Before choosing a plan, take these steps:
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Use the Medicare Plan Finder to compare benefits, star ratings, costs, and provider networks.
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Review the plan’s Summary of Benefits and Evidence of Coverage to understand actual coverage, not just marketing.
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Check the plan’s provider directory to make sure your preferred doctors and facilities are in-network.
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Confirm prescription drug coverage by checking the formulary and preferred pharmacies.
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Look for plan changes in the Annual Notice of Change (ANOC) letter if you are already enrolled in a Medicare Advantage plan.
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Speak to a licensed agent for personalized help in comparing options.
When It Comes to Medicare Advantage, Clarity Is Key
Choosing a Medicare Advantage plan in 2025 requires more than picking the one with the best score or the most perks. What you really need is a plan that reflects your health conditions, financial preferences, travel habits, and provider relationships.
Take the time to compare all aspects of coverage, especially:
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Network restrictions
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Out-of-pocket cost structure
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Prescription drug rules
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Supplemental benefit limitations
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Geographic service areas
If you need help making sense of your options, reach out to a licensed agent listed on this website. They can walk you through the details and help you make a confident, informed decision.
