As Employers Weigh Retiree Benefit Options, EGWPs Gain Steam

As the Medicare Advantage program continues to see double-digit enrollment increases, it’s not just individual consumers who are flocking to private plans, which now enroll 43.8% of Medicare-eligible beneficiaries, according to recent CMS data. MA organizations and industry experts report a growing interest in Employer Group Waiver Plan (also commonly referred to as “group Medicare”) offerings for retirees, and EGWP enrollment is growing at an average rate of about 6% per year (see infographic, p. 6).

Of the roughly 27.7 million MA enrollees as of August 2021, about 18% (or nearly 5 million) are enrolled in an EGWP, according to AIS’s Directory of Health Plans (DHP). Approximately 80 carriers across the U.S. offer 952 such plans, more than three-quarters of which are PPOs and nearly two-thirds of which feature a Part D benefit. The usual big names — UnitedHealthcare, CVS Health Corp.’s Aetna, Humana Inc. — dominate the market, while about 18% of overall membership is covered by a Blue Cross and Blue Shield plan. That includes Blues plans owned by Anthem, Inc., which stands to nearly double its EGWP membership with the addition of New York City retirees and their dependents next year. Moreover, Anthem in June acquired the Medicare and Medicaid assets of InnovaCare Health, which included group Medicare plans in Puerto Rico.

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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