Becker’s Healthcare Podcast Jakob Emerson on Medicare Advantage Changes, GLP-1 Access and Shifts in the Payer Landscape
Dec 4, 2025
Jakob Emerson, Associate News Director at Becker's Healthcare, explores critical developments in Medicare Advantage and healthcare accessibility. He discusses the proposed 2027 Medicare Advantage rule and the frustrations health systems face with MA plan denials. Jakob reveals troubling trends in GLP-1 medication access on ACA marketplaces, urging attention to geographic disparities. The conversation delves into complexities between payers, providers, and consumers amidst growing regulatory scrutiny and market pressures.
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Easier Plan Switching After Network Disruption
- CMS proposed a 2027 Medicare Advantage rule to ease disruptions when providers leave a plan's network midyear.
- The rule would create a modified special enrollment period so affected beneficiaries can switch plans more easily.
Health Systems Dropping Problematic MA Carriers
- Health systems have been dropping problematic Medicare Advantage carriers due to high prior-authorization denials and slow reimbursements.
- Some systems even refuse Medicare Advantage entirely after repeated operational frustrations, Jakob Emerson reported from industry interviews.
Risk Adjustment Scrutiny Could Help Smaller Plans
- CMS asked for feedback on risk adjustment and coding practices that may favor large MA plans.
- The agency acknowledges current rules may disadvantage smaller, regional Medicare Advantage plans and encourage intensive coding.