Picking a health plan? Check the hospitals and nursing homes in its network

Most people compare health plans on premium and deductible. Those matter. But when something serious happens, what matters most is where you'll actually get care, and that's decided by the plan's network.

Why networks matter more than you think

• A Medicare Advantage HMO usually won't pay for a non-emergency stay at a hospital outside its network.
• After a hospital stay, a plan may only cover rehab at certain nursing homes, and often needs to approve the stay first.
• Home health and hospice agencies have to be in network too.

So the "best" plan on paper can steer you toward a 2-star nursing home if that's who it contracts with.

How to check before you enroll

1. Make a short list of the places you'd want: your hospital, a couple of nursing homes near family, a home health agency.
2. Look them up here and check their ratings, inspection results and staffing.
3. Use each plan's provider directory, or call the plan, to confirm they're in network for the plan you're considering. Insurers often have several networks.
4. Ask how the plan handles nursing home rehab: is prior approval needed, and does it require a hospital stay first? Original Medicare requires a 3-day inpatient stay. Some Medicare Advantage plans waive it.

If someone already lives in a nursing home

Some Medicare Advantage plans are Institutional Special Needs Plans, built for people who live in nursing homes and often coordinating care on site. If your relative is a long-term resident, ask the nursing home which plans it works with.