How to Verify a Nursing Home Is In Network for Your Exact Medicare Advantage Plan

A nursing home saying “we take Medicare Advantage” is not enough.

Medicare Advantage networks are plan-specific. A facility may participate with one plan from an insurer and not another plan offered by the same company.

Verify the exact plan and exact facility location with both the health plan and the nursing home before relying on network status.

Identify the exact plan

Record:

• insurer;
• full plan name;
• plan type (HMO, PPO, SNP, etc.);
• member ID;
• plan contract/plan identifiers if available; and
• service area.

Do not ask only, “Do you take Blue Cross?” or another insurer brand.

Identify the exact facility

Record:

• nursing-home name;
• street address;
• phone;
• CMS Certification Number if known; and
• proposed level of care (SNF rehab versus long-term residence).

A chain can have different network contracts by location.

Call the plan

Ask:

“Is [facility name/address] in network for skilled nursing facility services under my exact plan on the proposed service date?”

Then ask:

• Is prior authorization required?
• Is the facility still in network on the expected admission date?
• What copayment/coinsurance applies?
• Is a referral needed?
• Does a specific network tier apply?
• Is there a reference number for this call?

Call the facility too

Ask admissions/business office to verify that it participates with the exact plan.

Give the full plan name, not just the insurer.

Ask whether they have successfully billed that plan recently for SNF care.

Do not treat facility confirmation alone as the final coverage decision.

Recheck before transfer

Medicare notes that Medicare Advantage networks can change.

If the admission is delayed or crosses a plan year, recheck.

Keep written evidence

Save:

• provider-directory screenshot/PDF;
• plan call reference;
• facility confirmation;
• authorization number; and
• date/time.

A provider directory can be outdated, so pair it with direct confirmation.

Network verification card

Plan: ____________________

Member ID: ____________________

Facility/address: ____________________

Facility CCN: ____________________

Plan says in network: Yes / No / Conditional

Facility says contracted: Yes / No

Prior auth required: ____________________

Expected member cost: ____________________

Plan reference number: ____________________

Recheck date: ____________________

Frequently asked questions

If the facility is in network, is admission approved?

No. Network status and clinical/authorization approval are separate.

If it is a PPO, can we go out of network?

Often PPOs allow out-of-network care at higher cost, but verify the specific plan and service.

If the hospital says it is in network, is that enough?

No. Confirm with the plan.

The practical goal

Verify exact plan + exact facility + exact service + exact dates.

That is much safer than relying on “they accept our insurance.”

Related NHP guides

• Medicare Advantage vs Original Medicare for Rehab: Questions to Ask
• A Bed Is Available, but Admission Is Not Approved

Primary sources checked

• Medicare — How to get Medicare services
• Medicare — Understanding Your Medicare Advantage Plan’s Provider Network
• Medicare — Compare Medicare Advantage plan types

*Editorial/source review: October 15, 2026. General education only. Notice rights, network status, prior authorization, billing liability, and appeal deadlines must be confirmed from the beneficiary’s actual plan and documents.*