Key Takeaways
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Medicare Advantage plans often come with attractive extras, but they may not offer flexibility for travel, specialist access, or out-of-network care.
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Even plans with high CMS star ratings may impose significant restrictions that could affect your ability to see the doctors you want or receive care while away from home.
Medicare Advantage in 2025: What Still Appeals to Many
In 2025, Medicare Advantage (Part C) continues to be popular because it combines Medicare Part A (hospital insurance) and Part B (medical insurance) into one plan. Many of these plans also include prescription drug coverage and additional perks like dental, vision, and wellness programs.
CMS (Centers for Medicare & Medicaid Services) rates Medicare Advantage plans annually on a 5-star scale. Plans with 4 stars or more are generally considered high quality based on metrics like preventive care, chronic condition management, and customer service.
However, a 5-star rating doesn’t mean the plan is right for you—especially if you value flexibility, travel, or specialist access.
Network-Based Care Still Rules Most Medicare Advantage Plans
One of the defining features of Medicare Advantage is that most plans are network-based. The two most common types are:
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HMO (Health Maintenance Organization): Requires referrals for specialists and restricts you to a local network except in emergencies.
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PPO (Preferred Provider Organization): Offers some out-of-network coverage but at a higher cost.
These structures may work well if your care is routine and local. But if you travel frequently, split time between different states, or need ongoing specialist care, they can become limiting.
Travel Limitations That May Affect Your Coverage
Medicare Advantage plans typically include service areas, meaning you must live in the plan’s service area and get most of your care there. This presents problems for:
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Snowbirds or seasonal travelers who live in different locations throughout the year
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Retirees with family in multiple states
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Frequent domestic travelers
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Those planning to relocate mid-year
While emergency care is generally covered nationwide, routine or specialist care outside your plan’s service area may not be covered or may come with significant out-of-pocket costs.
CMS allows you to switch plans if you move out of your service area, but otherwise, you’re locked in for the calendar year unless you qualify for a Special Enrollment Period.
Referral Requirements That Can Delay Care
HMO Medicare Advantage plans often require referrals from a primary care physician (PCP) before you can see a specialist. This can introduce delays in diagnosis or treatment, especially if your PCP has a long waitlist or if you need a second opinion.
Even if your plan includes many in-network specialists, the extra steps involved in securing a referral can create friction. This is especially frustrating when dealing with time-sensitive conditions.
Referrals also introduce another point of failure. If paperwork is delayed, misfiled, or incomplete, you may face denied claims or postponed appointments.
Specialist Access May Be Limited—Even in High-Rated Plans
You might assume a plan with a 4- or 5-star CMS rating gives you access to top-tier specialists. That’s not always the case.
In 2025, many high-rated plans still operate within narrow networks. This means:
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The plan contracts with only a limited number of providers in each specialty.
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Your preferred or long-time specialist may not be included.
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You may need to travel further to see an in-network specialist.
It’s essential to check if your specialists are covered before enrolling. Otherwise, you may be forced to either pay out-of-pocket or switch to a less familiar provider.
Out-of-Network Coverage Is Not Always Guaranteed
Even PPO plans, which offer some out-of-network coverage, may not be ideal. They typically come with:
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Higher deductibles
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Increased copayments or coinsurance
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Separate out-of-pocket maximums for in-network and out-of-network services
In 2025, PPO Medicare Advantage plans have an in-network out-of-pocket maximum of $9,350. The combined in- and out-of-network maximum can go up to $14,000. That’s a significant financial exposure if you frequently use providers outside your plan’s network.
For those with chronic or complex medical needs, the risk of needing out-of-network services may be high, making these limits a critical factor in your decision.
CMS Star Ratings Don’t Measure What Matters Most to You
The CMS star rating system evaluates:
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Preventive services
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Chronic condition management
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Customer service and complaints
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Member experience
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Drug plan quality
However, the rating doesn’t assess:
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Network breadth or geographic coverage
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Ease of seeing specialists
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Restrictions on referrals
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Flexibility while traveling
So even if a plan has a top rating, it may fall short in the areas that matter to your lifestyle. Use star ratings as one of many decision points, not your sole guide.
Annual Changes Can Affect Your Experience Mid-Retirement
Plans update their networks, costs, and benefits annually. That means:
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Your doctors may leave the network.
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Deductibles and copayments may increase.
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Covered medications may be dropped or moved to higher tiers.
In short, what worked well in 2024 may not suit you in 2025. The Annual Notice of Change, sent each fall, outlines all modifications. You need to review this document carefully—especially if you rely on specific providers or medications.
What to Do if You Travel Often or Live in Multiple Locations
If your lifestyle includes frequent travel or dual residency, you should:
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Review plan service areas: Make sure both locations are covered or consider plans with nationwide access.
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Ask about visitor/travel benefits: Some plans have temporary reciprocal arrangements, but they vary by carrier.
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Consider Original Medicare with Medigap: This may offer greater flexibility for multi-state coverage, though it comes with its own set of trade-offs.
Also consider how your prescriptions will be filled across state lines and whether you can get lab or diagnostic services when away from your primary residence.
Enrollment Periods and Why Timing Matters
The Medicare Open Enrollment Period runs each year from October 15 through December 7. During this time, you can:
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Switch from Original Medicare to a Medicare Advantage plan
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Switch from one Medicare Advantage plan to another
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Return from a Medicare Advantage plan to Original Medicare
Changes made during this period take effect on January 1 of the following year. If you find your current plan no longer works because of referral issues or travel limitations, this window is your chance to make a change.
There’s also a Medicare Advantage Open Enrollment Period from January 1 through March 31, allowing those already enrolled in a Medicare Advantage plan to:
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Switch to a different Medicare Advantage plan
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Disenroll and return to Original Medicare
However, you cannot switch from Original Medicare to Medicare Advantage during this period.
Out-of-Pocket Expenses Can Add Up Quickly
While Medicare Advantage plans typically have a cap on out-of-pocket expenses, these caps vary:
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In-network limits can be as high as $9,350 in 2025
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Combined in- and out-of-network limits can reach $14,000
These caps don’t include premiums or costs for services not covered by the plan. If you’re referred to an out-of-network specialist without proper authorization, or need routine care while traveling, these extra charges may apply.
For people with significant health needs or those who spend time away from their plan’s home network, the risk of hitting these thresholds is very real.
Picking a Plan That Actually Matches Your Life
Before choosing a Medicare Advantage plan, ask yourself:
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Do I need access to doctors in more than one state?
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Am I comfortable getting referrals for specialists?
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Are my current doctors included in the plan’s network?
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What are the in-network and out-of-network limits?
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How often do I travel or stay away from home?
These questions can help you move beyond marketing slogans and CMS ratings to make a decision based on how you live and what you value.
Think Beyond the Star Ratings
No plan is perfect, and the best plan on paper may not be best for you. Star ratings and added perks like gym memberships may sound appealing, but real-life usability matters more.
Always examine the provider directory, referral requirements, coverage limits, and customer support responsiveness. The real value of a plan is not just what it offers, but how well it works for your daily needs and health conditions.
Take the Next Step Toward Better Medicare Decisions
Choosing a Medicare Advantage plan in 2025 takes more than picking a top-rated option. You need to weigh how well the plan matches your lifestyle, healthcare preferences, and travel habits. If you’re unsure which path is right for you, speak with a licensed agent listed on this website. They can help you compare options and identify the plan that fits your unique situation.
