Medicare Advantage Patients Are Getting Shut Out of the Best Nursing Homes — And the Numbers Are Stark

A new national study has found that seniors enrolled in Medicare Advantage plans are markedly less likely to land in a top-rated nursing home after a hospital stay than people on traditional Medicare. The gap isn’t small, and researchers say the reason is built into how these plans operate.

The study, published in the November issue of Health Affairs, examined more than 1.45 million Medicare beneficiaries discharged from hospitals to skilled nursing facilities in 2022. Roughly 45% of them — about 654,500 people — were in Medicare Advantage plans.

Narrow networks, limited choices

Unlike traditional Medicare, which lets beneficiaries get care from any Medicare-participating provider, Medicare Advantage plans contract with a specific network of facilities. The design is meant to control costs and steer patients toward efficient care. But the researchers found it also walls patients off from some of the best options.

On average, MA enrollees had access to just 61% of the skilled nursing facilities in their local area. Those in plans with narrow networks were 22% less likely to enter a five-star-rated facility compared with traditional Medicare beneficiaries. Even people in plans with broader networks faced a 13% lower likelihood.

Proximity suffered too. Enrollees in narrow networks were 18% less likely to be admitted to the facility closest to their home; broader-network enrollees were 5% less likely.

Quality facilities get excluded

Perhaps the most troubling finding: facilities with stronger registered nurse staffing and higher overall quality were more likely to be left out of MA networks entirely. That pattern held even in plans with relatively wide networks, according to the researchers.

The burden doesn’t fall evenly, either. Black, Hispanic and Asian beneficiaries, along with people dually eligible for Medicare and Medicaid, were more likely to be enrolled in plans with the narrowest nursing home networks. Past reporting has shown similar access gaps elsewhere in the system — including research finding that nursing homes serving the most residents of color often receive the worst Medicaid rates.

Federal rules currently require MA plans to include at least one skilled nursing facility within specified travel distances and times. The study’s authors called those standards weak, writing that regulations governing SNF network adequacy “lack stringency” and that policy efforts should focus on getting more high-quality facilities into networks.

The stakes are considerable. About one in five Medicare beneficiaries needs skilled nursing care after a hospitalization, and where they land can shape their entire recovery. Simply having a bigger network isn’t enough, the authors argue — plans must actually include high-quality facilities and make them reachable for the people they cover.