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A study in the November 2026 issue of Health Affairs found that Medicare Advantage enrollees discharged to skilled nursing facilities in 2022 were less likely than traditional Medicare beneficiaries to receive care at five-star facilities or the closest facility to home. Researchers linked the differences to plan networks, which sometimes excluded higher-quality nursing homes; the study does not establish that network design alone caused the outcomes.
People enrolled in Medicare Advantage were less likely than traditional Medicare beneficiaries to receive care at a five-star skilled nursing facility after hospitalization, according to a study published in the November 2026 issue of Health Affairs. The researchers also found that MA patients were less likely to be discharged to the nursing facility closest to home, raising concerns about whether plan networks give patients access to high-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%, were enrolled in Medicare Advantage. On average, those enrollees had access to 61% of local facilities, the report said.
Compared with traditional Medicare beneficiaries, patients in MA plans with narrow skilled nursing 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 closest facility to home, the corresponding figures were 18% less likely for narrow-network enrollees and 5% less likely for broader-network enrollees.
The researchers also found that facilities with stronger registered nurse staffing and other indicators of higher quality were more likely to be excluded from MA networks. The report says this pattern remained even in plans with relatively broad networks. These are comparisons in the study, not proof that network size or exclusion alone caused each patient’s placement.
Network Design Shapes Nursing Home Access
Skilled nursing facilities provide rehabilitation and other care after a hospital stay, and the report says about one in five Medicare beneficiaries receives skilled nursing care after hospitalization. Facility choice can affect how easily patients reach care, including whether they can recover near home and family.
Medicare Advantage plans negotiate networks of contracted providers, unlike traditional Medicare, which generally allows beneficiaries to use any provider participating in Medicare. Networks can be part of plans’ efforts to manage costs and coordinate care. But the findings suggest that a network may be broad in number while still leaving patients with limited access to higher-rated facilities.
The study also identifies potential equity concerns. Black, Hispanic and Asian beneficiaries, along with people eligible for both Medicare and Medicaid, were more likely to be enrolled in plans with narrower skilled nursing networks. The findings point to possible differences in access, though they do not by themselves establish why those groups experienced those network conditions or measure the resulting health effects.
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How Medicare Advantage Networks Differ
Medicare Advantage is the private-plan alternative to traditional Medicare. MA plans contract with providers and generally limit coverage to their networks, subject to program rules. Traditional Medicare beneficiaries generally may receive care from any provider that participates in Medicare.
Federal network-adequacy rules for MA plans set minimum access requirements for skilled nursing facilities, including specified travel distances and times. The study authors say those requirements may not sufficiently protect access to quality care. They argue that measuring whether a plan has facilities in its network is not enough if higher-quality facilities are left out or are not genuinely accessible to members.
The report’s findings concern patients discharged to skilled nursing facilities in 2022; they do not describe every MA plan or establish whether networks have since changed. The study was published in Health Affairs in November 2026, according to Skilled Nursing News.
“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
Limits of the 2022 Findings
The reported comparisons do not show whether network restrictions were the sole reason patients entered particular facilities. The material available here does not provide details on how researchers accounted for individual patients’ clinical needs, hospital discharge practices, facility availability, or other factors that may influence placement.
The report also does not establish what happened to patients’ health outcomes after admission, or whether the observed differences persist in later years. It does not identify specific plans or facilities. The reported percentages describe relative differences in likelihood; the source material does not provide the underlying admission rates needed to translate them into absolute differences in patient numbers.
It remains unclear whether federal regulators will change network-adequacy standards or how any proposed changes would define and measure access to high-quality facilities.
Policy Debate Over Network Standards
The study authors call for stronger federal standards, with particular attention to including more high-quality skilled nursing facilities in Medicare Advantage networks. The report does not describe a specific proposed rule, regulatory timetable, or announced government response.
Further research and policy review would need to establish whether the 2022 patterns continue, how network design affects placement across different patient groups, and whether revised requirements improve access in practice. For now, the study provides evidence for policymakers and plan administrators to examine both the number of facilities in networks and their quality and accessibility.
Key Questions
What did the study find about Medicare Advantage patients?
The study found that MA enrollees discharged to skilled nursing facilities in 2022 were less likely than traditional Medicare beneficiaries to enter a five-star-rated facility or the facility closest to home.
How much less likely were patients to enter a five-star facility?
Compared with traditional Medicare beneficiaries, patients in MA 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.
Did the study prove that Medicare Advantage networks caused the differences?
No. The researchers reported associations between plan networks and facility placement and said narrow networks and exclusion of higher-quality facilities contributed to lower SNF quality. The findings do not establish that network design alone caused each placement.
Who was more likely to be enrolled in a narrower network?
The report says 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.
Could federal rules change because of the findings?
The authors argue that current network-adequacy standards may need strengthening, particularly to improve inclusion of high-quality facilities. The source material does not report an announced regulatory change or timetable.
Source: skillednursingnews.com
