If you or a loved one has ever needed a stint in a skilled nursing facility after a hospital stay — for rehabilitation after a hip replacement, stroke recovery, or wound care — you already know how important it is to have choices. What you may not know is that a quiet but consequential battle is being fought right now between skilled nursing facilities and Medicare Advantage insurers, and the outcome of that fight will shape where you can go for care, how long you can stay, and how much you'll pay out of pocket.
Skilled nursing facilities, often called SNFs (pronounced 'sniffs' in the industry), have long had a complicated relationship with Medicare Advantage plans. Under traditional Medicare, a beneficiary who qualifies for skilled nursing care after a hospital stay of at least three days is covered for up to 100 days in a SNF — the first 20 days at no cost, and days 21 through 100 with a daily coinsurance of $209.50 in 2025. Medicare Advantage plans are required to cover the same benefit, but they have far more flexibility in how they manage and pay for it. That flexibility has become a major source of tension.
The core problem is prior authorization. Medicare Advantage plans can — and routinely do — require facilities to get approval before admitting a patient, and then again to continue care beyond a certain number of days. Facilities report that these approvals are frequently denied or cut short, sometimes within days of a patient arriving, even when the patient's clinical condition clearly warrants continued care. A 2022 report from the HHS Office of Inspector General found that 13 percent of Medicare Advantage prior authorization denials for post-acute care were for services that would have been covered under traditional Medicare — meaning the denials were, by the government's own assessment, inappropriate. For skilled nursing operators running on thin margins, absorbing the cost of care that insurers refuse to pay for is simply not sustainable.
This has pushed many skilled nursing facilities to adopt one of three broad strategies when dealing with Medicare Advantage contracts: negotiate harder using real data, form partnerships with hospitals and health systems to gain leverage, or walk away from certain plans entirely. Each approach has direct consequences for beneficiaries enrolled in those plans.
The data-sharing strategy is perhaps the most sophisticated. Some skilled nursing operators are now compiling detailed outcome metrics — readmission rates, average length of stay, functional improvement scores, infection rates — and presenting that information to Medicare Advantage insurers during contract negotiations. The argument is straightforward: if our facility produces better outcomes and gets patients home faster than the regional average, we should be paid accordingly, not squeezed to the same rate as a lower-performing competitor. In markets where insurers are competing aggressively for star ratings (Medicare Advantage plans are rated on a 1-to-5 star scale by CMS, and higher-rated plans receive bonus payments), this argument has real traction. A skilled nursing facility that demonstrably reduces hospital readmissions is worth more to a plan trying to protect its 4- or 5-star rating than a generic rate sheet would suggest.
The hospital partnership strategy works differently. When a skilled nursing facility aligns itself with a major hospital system — either through formal ownership, a preferred provider agreement, or a clinically integrated network — it gains negotiating power that a standalone facility simply doesn't have. Hospitals are essential to Medicare Advantage plans. An insurer cannot build a competitive network without hospital contracts, and hospitals know it. When a hospital system says 'our preferred SNF partners need to be in your network at acceptable rates,' insurers have a much harder time saying no. For beneficiaries, this can mean more stable access to high-quality post-acute care, particularly in regions where a dominant health system has organized its post-acute partners effectively.
But the third strategy — walking away — is the one that most directly affects you as a beneficiary right now. Across the country, skilled nursing facilities are terminating contracts with specific Medicare Advantage plans when reimbursement rates fall below the cost of providing care. This is not a fringe phenomenon. Major SNF operators have publicly disclosed that they are selectively exiting MA contracts in certain markets. When a facility drops a plan, beneficiaries enrolled in that plan lose in-network access to that facility. If you're hospitalized and your preferred rehabilitation facility is no longer in your plan's network, you may be directed to a different facility — one you didn't choose and may not have researched.
According to CMS.gov data, Medicare Advantage enrollment reached approximately 33.8 million beneficiaries in 2024, representing more than half of all Medicare-eligible Americans. With that scale comes enormous purchasing power for insurers — and enormous pressure on providers to accept rates that may not reflect actual costs. CMS data also shows that in 2024, beneficiaries in most U.S. counties had access to 40 or more Medicare Advantage plans, creating a highly competitive insurance market. But plan competition does not automatically translate into provider network stability, and the number of plans available in your county tells you nothing about whether your local skilled nursing facility accepts any of them.
The practical implication for anyone enrolled in or shopping for a Medicare Advantage plan is this: network verification is not optional, and it is not a one-time task. Medicare Advantage plans can change their provider networks mid-year under certain circumstances, and they routinely update networks at the start of each plan year on January 1. The Annual Enrollment Period runs from October 15 through December 7 each year, and this is your primary window to switch plans if you discover that your preferred providers are no longer in-network. There is also an Open Enrollment Period from January 1 through March 31, during which you can make one plan change — but you cannot use this period to switch to a Medigap (supplemental) plan unless you have a qualifying event.
If you are currently in a Medicare Advantage plan and want to know whether your local skilled nursing facilities are still in-network, the most reliable approach is to call the facility directly and ask whether they accept your specific plan — not just Medicare Advantage generally, but your specific plan name and plan ID number. Facilities that have dropped a plan may still appear in an insurer's online directory for weeks or months after the contract ends, because directory updates lag behind contract changes. The facility's billing department will give you the most current answer.
For beneficiaries who have the health and financial profile to qualify, traditional Medicare combined with a Medigap supplemental policy offers a fundamentally different relationship with skilled nursing care. Under this combination, you can go to any Medicare-certified skilled nursing facility in the country without prior authorization, and a Medigap Plan G or Plan N policy will cover most or all of your cost-sharing. The trade-off is that Medigap premiums can be substantial — average monthly premiums for a Plan G policy for a 65-year-old non-smoking woman range from roughly $100 to $200 depending on the state and insurer, and premiums rise with age. But for someone who anticipates needing post-acute care, or who has a chronic condition that makes skilled nursing stays likely, the freedom of movement and absence of prior authorization can be worth the premium cost.
It's also worth understanding that if you are already enrolled in Medicare Advantage and want to switch to traditional Medicare with a Medigap policy, you may face medical underwriting in most states — meaning insurers can charge you more or deny coverage based on your health history. There are exceptions. If you live in California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, or Oregon, your state has a birthday rule or similar guaranteed issue protection that gives you a window — typically 30 days around your birthday — to switch Medigap plans without medical underwriting. New York and Connecticut offer year-round guaranteed issue for Medigap. If you are in your first 12 months of a Medicare Advantage plan, you also have a federal trial right that allows you to return to traditional Medicare with guaranteed issue Medigap access.
The broader story here is about leverage and who has it. For years, Medicare Advantage insurers held most of the cards — they controlled access to millions of patients, and providers largely had to accept whatever rates were offered or lose access to that patient population. That dynamic is shifting, slowly, as skilled nursing facilities organize, share data, and make strategic decisions about which plans are worth participating in. Whether that shift ultimately benefits beneficiaries depends on whether it produces fairer contracts and more stable networks, or simply results in fewer facilities accepting Medicare Advantage at all.
What you can do right now, regardless of which direction the industry moves, is treat your Medicare Advantage network like a living document rather than a fixed fact. Before your next Annual Enrollment Period in October, call your preferred hospital, your preferred skilled nursing facility, and any specialist you see regularly, and ask each one whether they still accept your plan. If the answer is no for any of them, use the October 15 through December 7 window to compare alternatives at Medicare.gov's Plan Finder tool, which lets you filter by specific providers and see estimated annual costs based on your actual drug list and health conditions. The few hours you spend on that research could determine where you receive care during one of the most vulnerable periods of your life.