TL;DR
A study published in Health Affairs found that Medicare Advantage enrollees discharged to skilled nursing facilities in 2022 were less likely than traditional Medicare beneficiaries to enter five-star-rated facilities or the facility closest to home. Researchers said network limits and the exclusion of higher-quality facilities may contribute to the gap; the study does not establish that networks alone caused the differences.
A study published in the November 2026 issue of Health Affairs found that people enrolled in Medicare Advantage were less likely than traditional Medicare beneficiaries to enter a five-star skilled nursing facility after hospitalization in 2022. The researchers also found that Medicare Advantage patients were less likely to be admitted to the facility closest to home, raising concerns about whether plan networks give patients access to high-quality post-hospital care.
The researchers examined more than 1.45 million Medicare beneficiaries discharged from hospitals to skilled nursing facilities, or SNFs, in 2022. About 654,500 people, or 45% of the study group, were enrolled in Medicare Advantage. On average, those plans included 61% of the local SNFs available in the area, according to the report.
Compared with traditional Medicare beneficiaries, people in Medicare Advantage plans with narrow SNF networks were 22% less likely to enter a five-star facility. Those in plans with broader networks were 13% less likely. The study also found differences in proximity: enrollees in narrow networks were 18% less likely to go to the SNF closest to home, while those in broader networks were 5% less likely. These are relative comparisons reported by the researchers; the source material does not provide the underlying admission rates for each group.
Researchers reported that facilities with higher quality ratings and stronger registered nurse staffing were more likely to be excluded from Medicare Advantage networks. The pattern was present even among plans with relatively broad networks. The study also found that Black, Hispanic and Asian beneficiaries, as well as people eligible for both Medicare and Medicaid, were more likely to be enrolled in plans with narrower SNF networks.
Network Limits After Hospital Discharge
Skilled nursing care can be part of recovery after a hospital stay, and the report says about one in five Medicare beneficiaries receive this care after hospitalization. Where a patient is sent may affect their access to nearby services and facilities with higher ratings or stronger nursing staffing. The study documents differences in where patients receive care, rather than measuring the resulting health outcomes.
The findings are relevant to patients and families who may assume that a broad plan network includes the best available local facilities. Researchers argue that network size alone may not guarantee access if higher-quality SNFs are not included or are not practically accessible. The disparities also raise questions about whether current network standards protect groups more likely to be enrolled in narrower-network plans.
How Medicare Advantage SNF Networks Work
Traditional Medicare generally allows beneficiaries to receive care from any provider that participates in Medicare. Medicare Advantage plans, by contrast, contract with a defined set of providers. These networks are intended to help plans manage costs and coordinate care, but they can also limit the facilities available to enrollees after a hospital discharge.
Federal rules generally require Medicare Advantage plans to include at least one SNF within specified travel distances and times. The study authors say those requirements may not adequately address whether networks include enough high-quality facilities. Their analysis focuses on beneficiaries discharged to SNFs in 2022; it does not describe every plan or local market, and the supplied report does not identify the study’s authors or provide its full methods.
“This study found that narrow networks and the exclusion of high-quality SNFs from networks contributed to lower SNF quality in MA in 2022.”
— The study researchers, as quoted in Skilled Nursing News
Limits of the Study Findings
The reported findings show an association between Medicare Advantage enrollment and lower likelihood of admission to top-rated or nearby SNFs; they do not, on the information provided, establish that network restrictions alone caused those differences. The source material does not give absolute admission rates, confidence intervals, or detailed adjustments for differences among patients, plans and local facility markets.
It is also unclear whether the observed patterns have changed since 2022, how they vary across individual insurers or regions, and whether the facility-choice differences led to measurable differences in recovery or other patient outcomes. The authors’ policy recommendations are proposals, not announced federal changes.
Potential Changes to Network Standards
The report calls for policy efforts to strengthen Medicare Advantage SNF network requirements, with particular attention to including more high-quality facilities. The supplied source does not identify a specific proposed rule, agency action or implementation timeline. Any change would depend on further policy decisions and, potentially, additional evidence about access and patient outcomes.
For now, the study adds evidence to debate over whether federal standards should assess more than the presence of a facility within a travel range. Further analysis of current plan networks, local access, and differences in care and outcomes could clarify how widespread the reported gaps are and what protections would address them.
Key Questions
What did the study find about Medicare Advantage patients?
Among people discharged to skilled nursing facilities in 2022, Medicare Advantage enrollees were less likely than traditional Medicare beneficiaries to enter a five-star-rated SNF or the facility closest to home.
How large were the differences for five-star facilities?
The researchers reported that enrollees in narrow-network plans were 22% less likely to enter a five-star SNF than traditional Medicare beneficiaries. For those in broader-network plans, the difference was 13%. These are relative comparisons, and the source material does not provide the groups’ underlying admission rates.
Did the study prove that Medicare Advantage networks caused the gap?
No. The study reported differences and linked them to network breadth and facility exclusions, but the information provided does not establish that network design alone caused the results.
What policy change did the researchers suggest?
The researchers said network standards could be strengthened, particularly by requiring plans to include more high-quality skilled nursing facilities. The source does not describe a specific rule change or timeline.
Source: skillednursingnews.com
