Medicare Advantage (MA) enrollees were less likely than traditional Medicare beneficiaries to receive care at top-rated skilled nursing facilities (SNFs) following hospitalization, according to a new study published on Monday in Health Affairs.
MA enrollees were also less likely to be discharged to facilities closest to their homes, the study published in the November 2026 issue of Health Affairs found.
The findings suggest that the provider networks established by Medicare Advantage plans may limit patients’ choices and create barriers to accessing quality post-hospital care.
Researchers examined more than 1.45 million Medicare beneficiaries discharged from hospitals to skilled nursing facilities (SNFs) in 2022. Of those, approximately 654,500, or 45%, were enrolled in Medicare Advantage plans, who, on average, had access to 61% of local SNFs.
“This study found that narrow networks and the exclusion of high-quality SNFs from networks contributed to lower SNF quality in MA in 2022,” researchers said.
Unlike traditional Medicare, which generally allows beneficiaries to receive care from any Medicare-participating provider, MA plans establish networks of providers with which they contract. These arrangements are designed to control costs and encourage efficient care, but researchers say they can also restrict access to certain facilities.
Compared with traditional Medicare beneficiaries, those enrolled in MA plans with narrow provider networks were 22% less likely to enter a five-star-rated skilled nursing facility. Even beneficiaries in plans with broader networks were 13% less likely to receive care at a five-star facility.
Access to nearby facilities was also limited. Medicare Advantage enrollees in narrow networks were 18% less likely to be admitted to a SNF closest to their homes. Those in broader networks were 5% less likely.
Researchers also found that higher-quality facilities, including those with stronger registered nurse (RN) staffing levels, were more likely to be excluded from Medicare Advantage networks. This pattern persisted even in plans with relatively broad networks.
The implications are particularly concerning for vulnerable populations. 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 study’s authors suggest that simply having a larger network is not enough. Medicare Advantage plans must also include high-quality facilities and make them genuinely accessible to enrollees.
Current federal requirements offer relatively little protection, the authors note. Medicare rules generally require plans to include at least one SNF within specified travel distances and times for enrollees. Researchers argue that these standards may need to be strengthened.
“It is notable that current regulations pertaining to SNF network adequacy for MA organizations lack stringency,” the researchers wrote. “Policy efforts to improve upon these standards, with specific attention to increasing the number of high quality SNFs included in networks, could help improve access to high-quality care for MA enrollees in this high-risk setting.”
Skilled nursing facilities play an important role in recovery after hospitalization. About one in five Medicare beneficiaries receive skilled nursing care following a hospital stay.
