Unveiling the Hidden Value of Medicare Advantage Employer Group Waiver Plans: New Report by National Policy Institute

In a comprehensive new report, the National Institute for Public Employee Health Care Policy shines...

In a comprehensive new report, the National Institute for Public Employee Health Care Policy shines a spotlight on the increasingly critical role of Medicare Advantage Employer Group Waiver Plans (MA-EGWPs) in providing health coverage for retirees in the public sector. As health care costs continue to rise, this report comes at a pivotal moment for public sector employers seeking cost-effective and reliable options for their retired employees.

A Growing Trend in Health Coverage

Medicare Advantage plans have surged in popularity, with over half of all eligible Medicare beneficiaries now enrolled. Between 2018 and 2022, MA-EGWP enrollment saw a notable 27% increase, rising from 4.1 million to 5.2 million beneficiaries. This growth underscores the plan’s appeal as public sector employers—including those covering teachers, firefighters, and law enforcement officers—turn to MA-EGWPs to manage both immediate healthcare costs and long-term financial liabilities.

“MA-EGWPs provide employers with a coverage tool that delivers lower costs, flexible benefits, and protects retiree health and financial security,” said Marta Green, Executive Director of the Institute and former Chief of Health Plan Research and Administration at the California Public Employees’ Retirement System. “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.”

The Benefits of MA-EGWPs

The report delves into the multifaceted advantages of MA-EGWPs, highlighting several key benefits:

Robust Coverage and Supplemental Benefits: MA-EGWPs offer comprehensive coverage that often includes additional benefits not typically found in traditional Medicare plans. These can range from dental and vision care to wellness programs, providing a more holistic approach to retiree health.
Cost Savings and Financial Stability: By leveraging MA-EGWPs, public sector employers can achieve significant cost savings. These plans help reduce both immediate out-of-pocket expenses for retirees and long-term liabilities for employers, creating a more sustainable financial model.
Advancements in Health Equity: MA-EGWPs play a crucial role in addressing social risk factors and promoting health equity among retirees. The plans are designed to cater to diverse populations, ensuring that all retirees have access to the healthcare they need.
Payment Stability for Plan Sponsors: With more predictable and stable payments, MA-EGWPs provide financial security for plan sponsors, allowing them to better manage budgets and plan for the future.

A Call for Continued Research

While the report offers a detailed overview of the current landscape of Medicare Advantage and EGWP, it also emphasizes the need for ongoing research. Future studies will focus on the specific experiences of public sector employees with their EGWPs and the broader impact on beneficiaries. This research is essential for understanding how these plans can be further optimized to meet the needs of retirees.

The Institute’s commitment to enhancing public understanding of MA-EGWPs is evident in its ongoing efforts to conduct research, develop policy papers, and educate policymakers. As Marta Green highlighted, “Understanding the full scope of MA-EGWPs’ impact is crucial for informed decision-making and policy development.”

The National Institute for Public Employee Health Care Policy is a non-profit, nonpartisan organization dedicated to improving the healthcare plans available to public sector employees, retirees, and their beneficiaries. The Institute’s work includes conducting research, publishing issue briefs, and hosting events aimed at educating the policy community in Washington, D.C.

For more information and to access the full report, visit healthcarepolicy-institute.org.

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