Key Takeaways
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Some Medicare Advantage plans may look attractive but come with restrictive networks, high out-of-pocket limits, and poor customer service. These red flags are more common in plans with star ratings of 2.5 or lower.
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Identifying the worst Medicare Advantage plans takes careful review of plan documents, star ratings, and network access—not just advertising slogans or extra perks.
What the Lowest-Rated Medicare Advantage Plans Have in Common
Not all Medicare Advantage plans deliver on the promise of better, simpler healthcare. The worst plans in 2025 often share key features that result in delays, denials, and disappointment. These features tend to appear more frequently in plans with CMS star ratings of 2.5 or below.
Common traits include:
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Restricted Provider Networks: Limited access to doctors, specialists, and hospitals, especially outside urban areas.
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High Prior Authorization Requirements: Excessive delays before you can receive needed services.
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Weak Prescription Coverage: Tiered formularies that exclude common medications or require step therapy.
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High Out-of-Pocket Maximums: Annual limits close to the CMS threshold, which is $9,350 for in-network and $14,000 for combined in- and out-of-network in 2025.
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Low Member Satisfaction Scores: Poor ratings on customer service, billing clarity, and timeliness of care.
If your plan has any combination of the above, it might be time to rethink your coverage.
Why Star Ratings Matter More Than Perks
Medicare Advantage plans are rated annually by the Centers for Medicare & Medicaid Services (CMS) on a scale from 1 to 5 stars. While flashy extras like gym memberships or vision benefits might grab your attention, the star rating gives you a more accurate sense of quality.
In 2025, plans with star ratings of 2.5 or lower are flagged for underperformance. These ratings reflect:
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Clinical outcomes and preventive care
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Member complaints and plan responsiveness
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Customer service experiences
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Medication adherence and prescription services
Low-rated plans have historically failed to meet CMS benchmarks, and while one bad year can happen, persistent poor performance over two or more years signals serious systemic issues.
The Hidden Costs Behind Seemingly Affordable Plans
Many people are drawn to Medicare Advantage because of lower premiums compared to Original Medicare combined with a Medigap policy. But in the worst plans, cost-sharing quickly erodes any savings.
Typical hidden costs include:
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Specialist Copays: Often $30 to $60 per visit.
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Tiered Prescription Costs: Higher costs for brand-name or specialty medications.
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Hospitalization Coinsurance: Daily charges that add up quickly during inpatient stays.
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Out-of-Network Penalties: Limited or no coverage if you leave your plan’s network.
In the worst cases, these costs pile up, especially for individuals with chronic or complex conditions. You may end up paying more than you would under Original Medicare with supplemental coverage.
Prior Authorization Delays Can Disrupt Critical Care
Prior authorization is a tool insurers use to determine if a service is medically necessary before they approve it. While this can help control costs, it can also delay or deny important treatment.
In low-rated Medicare Advantage plans, prior authorization requirements are excessive. You might need approval for:
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Imaging tests like MRIs or CT scans
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Referrals to specialists
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Durable medical equipment
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Physical therapy or rehabilitation
When turnaround times for approvals are slow, or denials are frequent, patient care suffers. In 2025, CMS continues to monitor plans that abuse prior authorization policies.
Narrow Networks Limit Your Healthcare Options
A narrow provider network is one of the most common complaints among Medicare Advantage enrollees who regret their plan choice. The worst plans restrict access to:
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Specialists in fields like oncology, neurology, or cardiology
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Renowned hospitals and academic medical centers
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Providers in rural areas
If you travel, relocate seasonally, or simply want choice in your care, these restrictions may lead to surprise costs or inaccessible services.
Before enrolling or re-enrolling, always check:
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Whether your doctors are in-network
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If nearby hospitals accept the plan
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Availability of specialists for your health needs
Customer Service Shouldn’t Make You Feel Powerless
Another red flag in poorly rated Medicare Advantage plans is consistently bad customer support. This includes:
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Long call wait times
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Poor responses to complaints
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Misleading or unclear plan documents
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Billing issues that take months to resolve
In 2025, CMS tracks how often members file complaints or change plans mid-year due to service dissatisfaction. High churn rates typically signal ongoing service failures.
A good plan should make things easier, not harder. You deserve to understand your benefits, get clear answers, and receive timely responses.
Annual Notice of Change (ANOC): Read It Carefully
Each September, Medicare Advantage enrollees receive the Annual Notice of Change. This document outlines any upcoming plan changes effective January 1.
The worst plans often bury major cuts or cost hikes in the fine print. These may include:
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Dropped medications from the formulary
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Increased copayments or coinsurance
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New prior authorization rules
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Provider network changes
Carefully comparing your ANOC with the prior year’s plan can help you spot red flags before Open Enrollment begins in October.
Watch for Red Flags During Open Enrollment
Medicare’s Open Enrollment period from October 15 to December 7 is your annual chance to switch plans. But the worst Medicare Advantage plans often look appealing on the surface.
Here’s how they market themselves:
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Focused messaging on dental, vision, or over-the-counter benefits
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Emphasis on zero-dollar costs for select services
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Minimal details about network size, copay structure, or prior authorizations
To see past the marketing:
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Compare the plan’s star rating on the Medicare Plan Finder
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Review the Evidence of Coverage (EOC) document
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Ask about prior authorization policies
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Confirm provider access
A licensed agent can walk you through this process and explain what’s missing or misleading.
Enrollment Traps: When You Can’t Easily Switch
In some cases, people find themselves stuck in a low-quality Medicare Advantage plan due to enrollment timing. While you can switch plans during Open Enrollment, other periods are limited.
Key timelines include:
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Medicare Advantage Open Enrollment Period: January 1 to March 31. Allows you to switch to another Medicare Advantage plan or return to Original Medicare.
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Special Enrollment Periods (SEPs): Triggered by events like moving, losing employer coverage, or plan termination.
If you miss these windows, you may be locked into a poor plan for months. That’s why it’s critical to evaluate plan quality before enrolling.
Low Star Ratings May Signal Future Cuts or Termination
In 2025, CMS continues its policy of reviewing plans with consistently low star ratings. If a plan receives below 3 stars for three years in a row, CMS may terminate it.
While this protects enrollees in the long term, it can lead to instability. You may be forced to find a new plan quickly or default into Original Medicare if your plan is removed.
To avoid surprises:
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Check the plan’s rating history over several years
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Look for a pattern of declining performance
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Be cautious of plans hovering just above 2.5 stars
Your healthcare shouldn’t be jeopardized by a plan that’s on the verge of collapse.
Don’t Just Look for Perks—Look for Protections
It’s easy to be drawn in by plans that highlight extras like free dental cleanings, hearing aids, or grocery benefits. But the worst Medicare Advantage plans use these perks as distractions.
Instead, focus on:
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How care is delivered and authorized
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Total out-of-pocket costs
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Member satisfaction trends
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Access to specialists and hospitals
Plans that truly protect you offer stability, transparency, and access—not just shiny extras.
Plan Quality Requires Your Attention
Spotting a bad Medicare Advantage plan isn’t always easy. The language can be confusing, and the perks are designed to divert attention from limitations. But when your health is on the line, taking the time to evaluate plan quality is non-negotiable.
Don’t settle for plans that cut corners or keep you in the dark. Instead, explore better-rated options and ask the right questions before signing up.
If you need help sorting through your options or understanding plan differences, speak to a licensed agent listed on this website. They can walk you through the comparison process and help ensure you choose a plan that truly supports your health.
