Employer group waiver plans (EGWPs) are a type of Medicare Advantage plan offered to employees and retirees of certain companies, unions, or government agencies.
If you are retired or planning to retire soon, a group Medicare Advantage plan may be one of your insurance options.
These Group Medicare Advantage plans are also called employer group waiver plans (EGWPs). Insurance experts pronounce this acronym as “egg-whips.”
Many employers offer EGWPs to their retired or retiring employees. These Advantage plans may offer extra benefits as well as more relaxed enrollment guidelines.
Keep reading to find out more about EGWPs, including the benefits they offer you (and your family), as well as things to know before you sign up for one.
Group Medicare Advantage plans are insurance plans offered by employers or unions to their retirees. EGWPs are provided by private insurance companies that manage your company’s retiree Medicare benefits.
Under EGWPs, Medicare pays the insurance company a fixed amount to provide benefits. The employer also typically pays the insurance company an additional amount to offer extra benefits.
Group Medicare Advantage plans may offer services to their members that go beyond traditional Medicare Advantage (Part C) plans. Some examples include:
- lower out-of-pocket costs
- health education
- extra benefits
Medicare grants special waivers to insurance companies and their group Medicare Advantage plans. These waivers apply to enrollment periods, premiums, and service areas all of which benefit you as a retiree.
Nearly 76% of EGWPs, according to a 2018 study, are local Preferred Provider Organizations (PPOs).
A PPO is a type of insurance in which you pay the lowest fees if you use preferred or in-network doctors, hospitals, and other healthcare professionals. You can still use out-of-network professionals, but you will have to pay more.
EGWPs cover the same services as Medicare parts A, B, and D which include:
- hospitalization
- doctor visits
- prescription drugs
- testing
- other healthcare
They may also offer other benefits, such as dental, eye exams, foot care, or wellness classes.
Sometimes, EGWPs also offer drug coverage for spouses or dependents who aren’t yet eligible for Medicare due to their age.
The average premium for group Medicare Advantage will depend on how much an employer subsidizes the Medicare costs. While the monthly premiums are low for Medicare, you will usually have an out-of-pocket limit for other costs as well.
Other out-of-pocket costs may include:
- Copays: These are fees you pay for healthcare services at the time of care. You may have a copay every time you see a doctor on your plan. This fee may be higher for specialists.
- Deductibles: This is the amount you pay before your plan starts to cover your healthcare costs. This fee usually applies to services other than doctor’s visits.
- Coinsurance: Coinsurance is a percentage of the cost that you must pay for a medical service after your deductible has been met. Your EGWP will cover the rest of the cost for that service. For example, you may have to pay 20% for an X-ray, and your EGWP will pay the remaining 80%.
Your specific plan will determine whether you must pay any of these fees and if so, how much.
If your company (or former company) offers you an EGWP, you may need to talk with the company’s insurance representative. Some things to consider about EGWPs include:
- Your insurance coverage needs: Be sure to consider the medications you take and the doctors you see. This will help you to see whether the plan covers your prescriptions and healthcare professionals.
- The geographic area the plan covers: Look for hospitals and healthcare practices included in the network. Look for an in-network hospital near you in case you require immediate care.
- The plan’s star rating: The Medicare Advantage Star Ratings program rates Medicare Advantage plans on a scale of up to 5 stars. Medicare Advantage considers plans that earn 4 or 5 stars to be high quality.
- Other Medicare Advantage plan options: Compare the EGWP plan to other available Medicare Advantage plans in your area by visiting Medicare.gov/plan-compare. If you have a specific question, you can also call 800-MEDICARE.
Since insurance companies tailor EGWPs to each business, union, or government entity, you may be able to do most of your research through the insurance company that provides the plan and the benefits office at your company.
Group Medicare Advantage plans (also called EGWPs) can be an attractive benefit for you as an employee.
Sometimes, joining your company’s EGWP means you can get extra benefits that traditional Medicare Advantage doesn’t offer. Plus, you don’t have to follow the same rules regarding enrollment periods.
Talk with your former employer to find out if they offer an EGWP. It could save you money in the long run, especially if your former employer pays for some of the plan costs.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
