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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 reach five-star-rated or nearby facilities. The researchers linked the differences to plan networks that may leave high-quality facilities out, while noting that current federal network rules may not provide strong access protections.
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 five-star-rated skilled nursing facilities after hospitalization. The researchers also found MA enrollees were less likely to receive care at the facility closest to home, raising concerns that plan networks can limit access to quality post-hospital care.
The study examined more than 1.45 million Medicare beneficiaries discharged from hospitals to skilled nursing facilities in 2022. About 654,500, or 45% of the group, were enrolled in Medicare Advantage. Those enrollees had access, on average, to 61% of local skilled nursing facilities, according to the report summarized by Skilled Nursing News.
Compared with traditional Medicare beneficiaries, people in MA plans with narrow networks were 22% less likely to enter a five-star-rated facility. Those in plans with broader networks were 13% less likely. The study also found MA enrollees in narrow networks were 18% less likely to be admitted to the closest facility to their homes; the figure was 5% for those in broader networks.
Researchers reported that facilities with higher quality ratings and stronger registered nurse staffing were more likely to be excluded from MA networks. That pattern appeared even in plans with relatively broad networks. The findings describe associations in the study population; they do not establish that network design alone caused each patient’s placement.
Network Access Shapes Recovery Options
Skilled nursing facilities provide rehabilitation and other skilled care after a hospital stay. The report says about one in five Medicare beneficiaries receive skilled nursing care following hospitalization, making facility access a practical concern for a substantial number of older adults and other beneficiaries.
For patients and families arranging a discharge, a plan’s contracted facilities can shape which providers are available, including whether a highly rated or nearby facility is an option. The study’s findings also point to potential uneven effects: 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 skilled nursing networks. The analysis does not establish that every enrollee in these groups experienced restricted access, but it identifies a disparity in exposure to narrower networks.
Researchers argue that network size alone may not reflect meaningful access. A broad list of facilities may still offer limited choice if high-quality providers are absent or difficult to reach. That distinction matters for oversight of Medicare Advantage plans and for beneficiaries comparing coverage options.
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How Medicare Advantage Networks Differ
Traditional Medicare generally allows beneficiaries to receive care from any provider that participates in Medicare. Medicare Advantage plans contract with provider networks, including skilled nursing facilities. These arrangements are intended to manage costs and support coordinated care, but they can also narrow the facilities available to enrollees.
Federal rules require MA plans to include at least one skilled nursing facility within specified travel distances and times. The study authors contend those standards provide limited protection for access to high-quality facilities, because meeting a minimum geographic requirement does not necessarily mean a plan includes the best-rated local options.
The report is based on discharges in 2022, and its findings were published in Health Affairs in November 2026. It compares placement patterns among beneficiaries in traditional Medicare and MA plans, including plans with different network breadth. The source material does not provide further detail on the study’s methods or the specific rating measures beyond the reported five-star category and staffing findings.
“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 Skilled Nursing News
Limits of the Placement Findings
The reported results show differences in where beneficiaries received care, but the supplied study summary does not explain all factors that may influence facility selection. It is not clear from the source material how much of the difference reflects plan network restrictions, patient preferences, facility capacity, clinical needs, or other discharge decisions.
The study covers 2022 discharges; the source does not establish whether the same patterns have continued in later years or how results vary across individual plans and regions. It also does not report whether the observed placement differences led to different recovery outcomes for patients. The researchers’ concerns about network rules are their interpretation of the findings, rather than evidence that every MA network excludes high-quality care.
Potential Changes to Network Rules
The researchers call for policy efforts to strengthen network-adequacy standards, particularly by increasing the number of high-quality skilled nursing facilities included in Medicare Advantage networks. The source material does not identify a specific proposed rule, implementation date, or federal action already underway.
For now, the study adds evidence for policymakers and plan overseers considering whether current distance-based requirements capture access to suitable care. Further research would be needed to establish how network design affects patient outcomes and whether changes to network standards improve placement and quality. The timing and form of any regulatory response remain unclear.
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 facility or the facility closest to home.
How many people were included in the analysis?
The study 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 placements?
The researchers linked narrow networks and the exclusion of high-quality facilities to lower skilled nursing facility quality among MA enrollees. The summary describes placement differences but does not establish that network design alone caused each patient’s placement.
What policy change do the researchers recommend?
The authors say network-adequacy standards could be strengthened, with greater attention to including high-quality facilities. The source does not report that a specific rule change has been adopted or scheduled.
Source: skillednursingnews.com
