Medicare Advantage Plans Frequently Deny Skilled Nursing Facility Coverage

Two-thirds of SNFs experience Medicare Advantage denials or delays on a daily or weekly basis.

Medicare Advantage prior authorization (PA) policies are having a growing and tangible operational impact on skilled nursing facilities (SNFs), reshaping admissions, length-of-stay decisions, and revenue predictability. With Medicare Advantage (MA) now accounting for 54% of total Medicare enrollment, it is becoming the primary coverage pathway for beneficiaries seeking post-acute care in SNFs.¹

Unlike traditional Medicare, where prior authorization requirements are limited, 99% of MA enrollees are in plans that require prior authorization for SNF stays.² Requiring insurance approval before care can begin slows patient flow from hospitals, increasing the administrative burden for patient admission by often requiring detailed clinical documentation and repeated reviews.

A 2025 survey of 363 nursing home providers found that two-thirds of SNFs experience MA denials or delays on a daily or weekly basis. These decisions often run counter to clinical judgment with 67% of providers reporting cases where MA plans prematurely ended coverage against medical advice, forcing patients and families to either pay out-of-pocket or discharge early.³

Medicare Advantage Enrollment Projected To Grow

Percentage Of Total Beneficiaries Enrolled In Each Plan

Source: Plante Moran. Maintain Your Edge: 2026 Skilled Nursing Facility Medicare Benchmarking Report. January 5, 2026

However, many denials are ultimately reversed. Only 11.5% of denied Medicare Advantage PA requests are appealed, yet more than 80% of those appeals are partially or fully overturned. For providers, this creates a costly paradox: Necessary care is often approved, but only after delays, added documentation, and administrative expense.⁴

Operationally, these dynamics introduce three key challenges for SNFs:

• Uncertain admissions pipeline: Facilities face inconsistent approval patterns, complicating census management and discharge planning with hospital partners.
• Compressed length of stay: Even when admissions are approved, MA plans often authorize shorter stays, requiring frequent reauthorization and increasing staff workload.
• Revenue and cost pressure: High denial rates combined with low appeal rates mean SNFs may forgo reimbursement unless they invest in robust appeals processes—despite high overturn success.

Percent Of SNF Providers Reporting Denials And Delays Of Medically Necessary Post-Acute Care By Medicare Advantage, 2025

Source: AHCA. Provider Insights Report: Medicare Advantage. August, 2025