Medicare Advantage is more popular than ever, but health plans and members alike are confronting a range of setbacks heading into 2025, with lower star ratings and fewer in-network providers. Meanwhile, rising healthcare costs and changes to the federal payment model are squeezing profitability, causing some health plans to scale back their MA offerings.
Medicare Advantage (MA) plans are managed by private payers and often include prescription drug coverage as well as optional supplemental benefits such as vision, dental, and transportation—and low or no additional premiums. Enrollment has grown in recent years, with 54% of the eligible Medicare population (33 million seniors) now opting for MA. So what’s causing these shakeups?
1. Falling Star Ratings
The Centers for Medicare and Medicaid Services recently downgraded the star ratings of many Medicare Advantage plans for 2025. For next year, the average MA star rating is 3.92, down from 4.07 in 2024.
Encompassing up to 40 quality measures, CMS star ratings play a pivotal role in determining whether insurers qualify for Medicare bonuses: Health plans must earn at least a 4-star rating to get bonus payments from CMS. The ratings also help consumers make decisions when choosing a plan during the annual enrollment period, which started in October: Highly rated plans are more attractive to consumers.
The share of plans that have star ratings of 4 or above has been dropping over the past few years: In 2025, 40% of plans will have scores of 4 or above; in 2024, they made up 44% of plans; in 2023, 51% of MA plans crossed that threshold. The changes have prompted several lawsuits from major payers disputing how CMS calculated the star ratings: This year the agency changed how it calculates its quality thresholds, with higher cut points and some quality measures hinging on a few customer service calls.
Without the CMS bonus payments, it’s harder for health plans to cover valuable supplemental benefits such as fitness memberships and transportation, a pressing social driver of health. In a SafeRide Health survey of health plan leaders and other healthcare professionals, 84% said that transportation to medical care creates the greatest barrier to care.
2. Fewer Medicare Advantage Plans
Health insurance companies are facing several concurrent challenges in 2025. First, CMS made changes to the payment model and cut base payments—changes that health plans warned would affect their profitability. At the same time, plans are reporting higher healthcare utilization—partially driven by care that was delayed during the COVID-19 pandemic—which has also driven higher costs than expected.
As a result, several payers have said they are eliminating or contracting plans to help protect their profit margins. According to the health policy research organization KFF, the average MA enrollee will be able to choose from among 34 plans next year, compared to 36 in 2024.
While that’s still a lot of choices, it’s just an average; those numbers vary widely across states and counties. Mississippi is likely to see a 22.9% increase in the number of MA plans, for example, while Vermont is facing a 66.7% decrease, according to the Better Medicare Alliance.
“There are a handful of counties, more than in previous years, where all Medicare Advantage plans exited, and those look to be predominantly rural counties,” Jeannie Fuglesten Biniek, KFF Associate Director of the Program on Medicare Policy, told The Miami Herald. “We’re talking 40ish counties out of 3,000. For those people in those counties, that matters, but overall, it’s a smaller number.”
America’s Health Insurance Plans estimates that nationwide, about 1.3 million seniors will lose access to their current MA general enrollment plan, and the number of such plans will decrease by 6% compared to 2024. On the other hand, the number of Special Needs Plans is increasing by 8.5%.These plans typically include a range of benefits for SNP enrollees, including those who are dually eligible for both Medicaid and Medicare and those who have significant care needs.
Given the drop in general MA plans, healthcare experts are concerned about the impact on racial disparities: Research has shown that Black enrollees are more likely to live in a county with low-rated MA plans compared to White enrollees. Those low-rated plans tend to be the first on the chopping block.
Even members who can keep their current MA plan could feel the effects of these changes: An analysis from the Better Medicare Alliance based on 2025 CMS data from plans reported that the median out-of-pocket maximum for members would rise by 8% to $5,400 and there will be fewer supplemental benefits offered. As more people age and need new services—meal assistance when it becomes difficult to cook, non-emergency medical transportation when they can no longer drive, bathroom safety devices to address mobility issues—these benefits are likely to become more popular and even essential.
3. Fewer In-Network Providers
Across the nation, some MA members are getting the unwelcome news that their provider will no longer be considered in-network for their health plan. At least 30 health systems have decided to stop accepting Medicare Advantage, according to Becker’s Hospital Review.
Network changes often force seniors to pay more for out-of-network healthcare, if they want to stay with their care providers, or switch to a different provider—no easy decision, particularly for rural residents who may have only one provider close by. Hospitals have cited excessive prior authorization denials and slow insurance payments for the change, but payers have pushed back on that, and the negotiations are not public.
“There’s just a lot of changes that are going to affect a lot of beneficiaries,” Kelli Jo Greiner, a health care policy analyst with the Minnesota Board on Aging, told the Minnesota Star Tribune. An estimated 60,000 seniors in the state will be affected by such health system disruptions.