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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. The researchers linked the differences to plan networks that may exclude higher-quality facilities, while noting that federal network rules may offer limited protection.
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-rated skilled nursing facility after a hospital stay. The findings point to plan provider networks as a potential barrier to access to high-quality post-hospital care.
Researchers examined more than 1.45 million Medicare beneficiaries discharged from hospitals to skilled nursing facilities (SNFs) in 2022. About 654,500, or 45%, were enrolled in Medicare Advantage. Those enrollees had access, on average, to 61% of local SNFs, according to the study as reported by Skilled Nursing News.
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 still 13% less likely. The study also found lower likelihood of admission to the SNF closest to home: 18% less likely for narrow-network enrollees and 5% less likely for those in broader networks.
The researchers reported that facilities with stronger registered nurse staffing were more likely to be excluded from Medicare Advantage networks. The pattern appeared even among plans with relatively broad networks. These are comparisons from the study, not proof that a network restriction alone caused each patient’s placement; the source report does not provide further detail on how individual discharge decisions were made.
Network Limits May Shape Recovery Care
Skilled nursing facilities provide rehabilitation and other care after a hospital stay, making the choice of facility relevant to patients’ recovery and families arranging care. The source report says about one in five Medicare beneficiaries receive skilled nursing care after hospitalization. If a plan’s network excludes nearby or highly rated facilities, patients may have fewer options at a point when discharge decisions are time-sensitive.
The study also raises an access concern for populations more often enrolled in narrower networks. Its authors 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. The findings identify a pattern in network access; they do not establish that every person in these groups receives lower-quality care.
For patients and caregivers, the results suggest that the number of facilities in a network may not tell the whole story. Whether the network includes high-quality facilities that are practically reachable may also matter.
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How Medicare Advantage Networks Differ
Traditional Medicare generally allows beneficiaries to receive care from any provider that participates in Medicare. By contrast, Medicare Advantage plans contract with provider networks. The arrangements are intended to manage costs and support efficient care, but they can limit which facilities 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 researchers argue that these standards may not be strong enough to secure access to a meaningful range of high-quality facilities. Their analysis focuses on hospital-to-SNF discharges in 2022; the report does not describe it as an evaluation of later enrollment years or current network performance.
“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
What the 2022 Findings Cannot Show
The findings describe patterns among beneficiaries discharged to SNFs in 2022; they do not establish whether the same gaps persist in later years or across every Medicare Advantage plan and region. The source report does not provide plan-level results, the study’s full methods, or details on how factors such as clinical needs and facility availability affected individual placement decisions.
The reported associations also do not show that network design was the sole reason a patient entered a particular facility. It remains unclear from the available report how often patients or families preferred an out-of-network facility, whether alternatives were available at discharge, or what the resulting differences meant for patient outcomes.
Policy Review and Future Network Data
The researchers call for stronger network-adequacy standards, with specific attention to including more high-quality SNFs in Medicare Advantage plans. The report does not identify a federal rule change or a timetable for one. Any policy response would require action by the relevant federal agencies or lawmakers.
Further research and updated network data could show whether the patterns persisted after 2022, how access varies by location and plan, and whether changes to network rules improve patients’ ability to reach suitable facilities. For now, the study documents disparities in facility access and offers a policy argument; what regulators will do next is not yet clear.
Key Questions
What did the study find about Medicare Advantage patients?
Among beneficiaries discharged to skilled nursing facilities in 2022, Medicare Advantage enrollees were less likely than traditional Medicare beneficiaries to enter a five-star-rated facility and less likely to go to the facility closest to home.
How large were the differences for five-star facilities?
Compared with traditional Medicare beneficiaries, those in Medicare Advantage plans with narrow networks were 22% less likely to enter a five-star facility. Those in broader-network plans were 13% less likely, according to the study.
Does the study prove that Medicare Advantage networks caused the differences?
The researchers link network limits and the exclusion of higher-quality facilities to lower SNF quality for Medicare Advantage enrollees. The available report describes comparative findings, but does not establish that network design alone determined each patient’s placement.
Which groups were more likely to be in narrower networks?
The study found that Black, Hispanic and Asian beneficiaries, along with people eligible for both Medicare and Medicaid, were more likely to be enrolled in Medicare Advantage plans with narrower SNF networks.
What policy change do the researchers recommend?
They argue that network-adequacy standards should be strengthened, particularly by increasing the number of high-quality SNFs included in plan networks. The report does not say that any such change has been adopted.
Source: skillednursingnews.com
