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A study published in Health Affairs found 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. The authors linked the differences to plan networks, which may exclude high-quality facilities, and said federal network standards may need strengthening.
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. The researchers also found lower access to the facility closest to a patient’s home, raising questions about how plan networks shape access to post-hospital care.
The study examined more than 1.45 million Medicare beneficiaries discharged from hospitals to skilled nursing facilities (SNFs) in 2022. About 654,500 patients, or 45% of the study group, were enrolled in Medicare Advantage. Those enrollees had access, on average, to 61% of local SNFs, 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-rated facility. Those in plans with broader networks were 13% less likely. For admission to the SNF closest to home, the differences were 18% and 5%, respectively, for narrow- and broader-network plans.
The researchers also reported that facilities with stronger registered nurse staffing and higher quality ratings were more likely to be excluded from Medicare Advantage networks. The pattern appeared even among plans with relatively broad networks. These are study findings describing associations; the supplied report does not establish that network design alone caused individual patients’ placements.
Network Limits Shape Nursing Home Access
Skilled nursing care is a common part of recovery after a hospital stay: the report says about one in five Medicare beneficiaries receive it. Where patients go can affect access to nearby care and to facilities with higher ratings or stronger staffing. The study suggests that being enrolled in a plan with a broad network does not necessarily mean a patient can reach a top-rated facility, if those facilities are not included or are otherwise difficult to access.
The findings also point to potential differences in exposure to network limits. According to the study summary, 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. The report does not provide subgroup outcome estimates, so it does not establish the size of any resulting difference in access to high-rated facilities for these groups.
For patients and families making post-hospital care decisions, the results highlight a practical issue: a facility’s quality and distance may not be the only factors determining where a Medicare Advantage enrollee can go. Plan networks can narrow the available options, while traditional Medicare generally allows beneficiaries to use any provider participating in Medicare.
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How Medicare Nursing Networks Work
Traditional Medicare generally allows beneficiaries to receive care from any provider that participates in Medicare. Medicare Advantage plans, by contrast, contract with networks of providers. These arrangements are intended to manage costs and encourage efficient care, but they can also limit which SNFs are available to enrollees.
Federal rules generally require Medicare Advantage plans to include at least one SNF within specified travel distances and times for enrollees. The study authors said those requirements offer limited protection when the facilities that meet minimum geographic standards are not high quality or are not readily accessible. The study focused on hospital discharges to SNFs in 2022; the source report does not describe changes in plan rules or networks after that period.
“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’s researchers, as quoted in the report
Questions About Access and Cause
The report summarizes differences in where patients received care but does not establish why each placement occurred. It is not clear from the source material how much the results reflect network exclusions, patient or family preferences, facility capacity, discharge decisions, or other factors. The reported associations should not be read as proof that network restrictions alone caused lower-quality placements.
The source also does not provide details on differences among individual plans, states, or types of SNFs, nor does it report patient outcomes such as recovery, readmission, or later health. It is unclear whether network patterns have changed since the 2022 study period or how the findings apply to current plan offerings. The report supplies no specific proposal, timetable, or federal agency response to the researchers’ call for stronger standards.
Potential Changes to Federal Standards
The researchers recommend that policy efforts strengthen network adequacy standards, with specific attention to adding more high-quality SNFs to Medicare Advantage networks. The report does not identify a scheduled regulatory action or say that federal officials have adopted the recommendation.
Further scrutiny of plan networks and their facility quality could help clarify whether the 2022 patterns persist. Any assessment of possible policy changes would also need to distinguish between having a facility listed in a network and patients’ practical ability to receive care there. For now, the study’s findings describe access during 2022, while the effect of any future rule changes remains unknown.
Key Questions
What did the study find about Medicare Advantage patients?
For patients discharged to SNFs in 2022, Medicare Advantage enrollees were less likely than traditional Medicare beneficiaries to enter a five-star-rated facility or the SNF closest to home, according to the study.
How did network size relate to access to five-star facilities?
Compared with traditional Medicare beneficiaries, enrollees in Medicare Advantage plans with narrow networks were 22% less likely to enter a five-star SNF; those in broader-network plans were 13% less likely. The figures describe the study’s comparisons and do not show that network size alone caused the difference.
How many beneficiaries were included?
The researchers examined more than 1.45 million beneficiaries discharged from hospitals to skilled nursing facilities in 2022. About 654,500, or 45%, were enrolled in Medicare Advantage.
Did the study prove that Medicare Advantage networks caused lower-quality care?
No. The report describes associations between plan enrollment, network characteristics and facility placement. It does not establish that network design alone caused individual patients to receive care at a lower-rated facility.
What policy change did the researchers recommend?
The authors said federal network standards could be strengthened, particularly by increasing the number of high-quality SNFs included in Medicare Advantage networks. The report does not say that regulators have adopted a change.
Source: skillednursingnews.com
