A Guide to Understanding Employer Group Waiver Plans (EGWPs)

Posted by: Simone Manlove

Created in the Medicare Modernization Act of 2003, Employer Group Waiver Plans (EGWPs) are a type of health plan offered to you by a public or private employer. Also known as, employer retiree Medicare Advantage plans or “egg whip”, represents a successful public-private partnership that addresses the health care needs of 4.1 million retirees out of 20 million Medicare Advantage beneficiaries.

EGWPs coverage delivers high-quality, value-based care. Employers have turned to EGWPs to provide more affordable options than Medicare Supplement Insurance policies for beneficiaries. These types of Medicare Advantage (MA) plans are profitable for larger populations such as local and state governments, industries and unions.

Egg Whip plans like other MA plans cover all Medicare Part A and Part B benefits in addition to supplemental benefits, vision, dental, out-of-pocket cost protections, and innovations to enhance beneficiaries care. Employers provide uniform plan designs to administer coverage to their retirees.

MA plans share many similarities with EGWPs however some differences do apply. The two main differences include: retirees are enrolled as groups rather than individuals so employers have to be compliance with a bigger population. Secondly, Egg Whip plans must include a larger geographic area than MA individual plans. Therefore, EWGP requires providers nationwide and most plans are PPO (Provider Organizations) rather than HMO (Health Maintenance Organizations). Retiree coverage those include a range of benefits for beneficiaries such as risk adjustment, cost protection, benefit design, quality and value and beneficiaries right.

The biggest benefit of Employer retiree plans is that it’s a seamless coverage between what you had before and worked for you. Rather than enrolling into Medicare and the process of understanding the new options you get the same plan from when you were an employee and get Medicare supplements added on. As beneficiaries, we need your support. Medicare Advantage retiree plans are at risk and we want the administration to know the importance they have to employers and retirees. Moving forward, we encourage you to learn more about EGWPs and help us advocate for these types of plans.

Better Medicare Alliance wants employer plans to have greater access in rural areas, simpler enrollment process, more use for professional or group associations, and education on the benefit. Our goal is to maintain the stability of a public-private venture that has proven to be successful.