Medicare Advantage and nursing home quality in the United States: a systematic review

A systematic review of seven eligible US studies found mixed evidence on whether skilled nursing facility quality differs between Medicare Advantage beneficiaries and those enrolled in Traditional Medicare. According to the review’s abstract, Medicare Advantage enrollment was consistently associated with a lower likelihood of admission to higher-rated skilled nursing facilities under the CMS Five-Star Quality Rating System, while several studies reported more favorable utilization outcomes among Medicare Advantage enrollees. The review concludes that the overall relationship is nuanced rather than uniform.

The review searched CINAHL Complete, PubMed, EconLit and Scopus and followed PRISMA 2020 reporting guidelines. Reviewers screened titles and abstracts, examined full texts and hand-searched reference lists. They included US-based cohort and cross-sectional studies comparing skilled nursing facility quality or related outcomes for Medicare Advantage and Traditional Medicare beneficiaries. Study quality and risk of bias were assessed with the Newcastle–Ottawa Scale. Thirty-three articles underwent full-text review, and seven met the final inclusion criteria. The abstract does not report whether the results were pooled quantitatively, so the available evidence supports a summary of the included studies rather than a single combined effect estimate.

The findings differed by outcome domain and by population. Medicare Advantage enrollment was associated with a lower likelihood of admission to facilities with higher CMS ratings, yet several included studies found more favorable utilization outcomes at both the beneficiary and nursing-home levels. The review’s abstract does not specify which measures comprised every utilization outcome, so those results cannot be interpreted as a general finding of better care. It also reports that associations varied between short-stay and long-stay populations. The authors interpret the combination of favorable utilization findings and concentration in lower-rated facilities as suggesting possible misalignment between managed-care incentives and dimensions captured by publicly reported nursing-home quality measures, particularly for long-stay residents.

The review is limited to seven included studies drawn from an evidence base of cohort and cross-sectional research, and the abstract characterizes the findings as mixed. It does not provide effect sizes, confidence intervals or quantitative pooling in the supplied text, limiting assessment of the magnitude and precision of the reported associations. The authors state that additional research is warranted on whether existing quality-measurement approaches capture the dimensions of post-acute care performance most relevant to managed-care settings. The available evidence therefore supports an association between Medicare Advantage enrollment and the studied skilled nursing facility outcomes, but it does not establish that enrollment causes changes in nursing-home quality or utilization.

Subject of Research: Systematic review of Medicare Advantage enrollment and US skilled nursing facility quality

Article Title: Medicare Advantage and nursing home quality in the United States: a systematic review

Article References: Kim, H., Mahmood, A., Dobalian, A., & Chang, C. F. (2026). Medicare Advantage and nursing home quality in the United States: a systematic review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15741-2

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DOI: 10.1186/s12913-026-15741-2

Keywords: Medicare Advantage, Traditional Medicare, nursing home quality, skilled nursing facilities, systematic review, health services research, quality ratings, post-acute care, Medicare, Advantage, nursing, home