The Impact of Medicare Advantage Employer Group Waiver Plans

Medicare Advantage (MA) plans, particularly Medicare Advantage Employer Group Waiver Plans (MA-EGWPs), have become increasingly popular among retirees.

The National Institute for Public Employee Health Care Policy released a new report sharing a deeper look at these plans and their value to the public sector.

According to the report, these plans offer stable costs and high-quality coverage, showcasing above-average satisfaction rates and are projected to take in 62% of all beneficiaries by 2033.

This shift towards MA-EGWPs highlights the growing trend among plans in the public sector who are providing health coverage to those such as teachers, firefighters and law enforcement members.

The report shared that in 2023, enrollment in MA surpassed original Medicare, with half of plan sponsors offering retiree benefits opting for MA-EGWPs. These plans address several critical factors for retirees and plan sponsors including:

• Benefits and Quality Oversight: MAEGWPs provide robust coverage and benefits for seniors, including built-in cost-sharing protections.
• Payment Stability: These plans ensure that funds coming in stays consistent and adjusts to account for potential risks, enabling plans to offer new benefits to members while ensuring financial sustainability.
• Flexibility: Employer Group Waiver Plans can adapt to meet retiree needs and respond to emerging healthcare trends, ensuring that beneficiaries receive tailored and relevant care.
• Health Equity and Social Risk Factors: MA plans play a crucial role in advancing equity and reducing health disparities within Medicare, ensuring that all beneficiaries have access to quality healthcare services.
• Impact of Legislation: With legislation such as the Inflation Reduction Act (IRA), it shapes the landscape for all Part D plans, including MA-EGWPs, with a focus on benefit design and Medicare drug negotiation to protect enrollees from excessive out-of-pocket costs.

"MA-EGWPs provide employers with a coverage tool that delivers lower costs, flexible benefits, and protects retiree health and financial security,” Marta Green, executive director and former chief of health plan research and administration at the California Public Employees' Retirement System said in a release. “As policymakers continue to refine plans to address the long-term affordability and funding of Medicare, there is a pressing need for further research to comprehend the current role of MA-EGWPs and the potential ramifications of proposed policy changes."

Given the role that MA-EGWPs play in retiree benefits for those in the public sector and the limited information available about this particular workforce, further research is suggested among authors of the study.

It’s also suggested that policymakers need a comprehensive understanding of the role MA-EGWPs currently play and the benefits they provide to ensure that retirees have access to affordable healthcare coverage.

Since the start of Medicare Advantage more than two decades ago, the popularity of MA plans has increased.

Though, the rise of Medicare Advantage Employer Group Waiver Plans represents a shift in how retirees access healthcare coverage.