Coverage – Cost – Chossing a plan

A Group Medicare Advantage plan may be one of your insurance alternatives if you are retired or expect to retire soon. These Group Medicare Advantage plans are also known as employer group waiver plans (EGWP), which insurance professionals refer to as “egg-whip.”
Many companies provide these to retired or retiring staff. These Advantage plans may provide you with additional advantages and more flexible enrollment requirements. Continue reading to learn more about EGWPs, the benefits they may provide you (and your family), and what you should know before enrolling in one.

What is an EGWP?

Group Medicare Advantage plans are insurance programs provided to retirees by businesses or unions. Private insurance firms that administer your company’s retiree Medicare benefits supply EGWPs.

Medicare pays the insurance firm a set sum to offer benefits under EGWPs. In addition, the employer often pays an additional sum to the insurance provider in order to provide additional benefits.

Benefits of an EGWP

  • lower out-of-pocket costs
  • health education
  • extra benefits

Group Medicare Advantage plans may provide services to its members that are in addition to those provided by standard Medicare Advantage plans. Here are several examples:

Insurance firms and their Group Medicare Advantage plans are granted specific waivers by Medicare. These exemptions include enrollment dates, premiums, and service locations, all of which benefit you as a retiree.

Nearly 76 percent of EGWPs are local preferred provider organizations (PPOs). A PPO is a form of insurance in which you pay the least amount of money if you utilize preferred or in-network physicians, hospitals, and other healthcare providers. You can continue to utilize out-of-network providers, but you will be charged extra.

What do Group Medicare Advantage plans cover?

EGWPs provide the same services as Medicare Parts A, B, and D, including hospitalization, doctor visits, prescription medicines, testing, and other healthcare. They may also include other benefits like dental, eye, and foot care, as well as wellness seminars. EGWPs may also provide prescription coverage for spouses or dependents who are not yet Medicare-eligible owing to age.

What is the cost of Group Medicare Advantage?

The average Group Medicare Advantage premium will be determined by how much a business subsidizes Medicare expenditures. While Medicare has modest monthly rates, you will likely have an out-of-pocket limit for other charges as well.
Other out-of-pocket expenses might include:

Copays. These are the costs you pay for healthcare services when you receive them. Every time you visit a doctor under your plan, you may be required to pay a copay. For experts, this charge may be greater.

Deductibles. This is the amount you pay before your plan begins to cover your medical expenses.
This fee is often charged for services other than doctor’s visits.

Coinsurance. Coinsurance is a portion of the cost of a medical service that you must pay after your deductible has been reached. The remainder of the cost for that service will be covered by your EGWP. For example, you may be required to pay 20% of the cost of an X-ray, with your EGWP covering the remaining 80%. Your specific plan will determine if you must pay any of these fees and if so, how much.

What is the best way to shop for Group Medicare Advantage plans?

If your current (or past) employer provides you with an EGWP, you should speak with the company’s insurance representative.
Some things to think about when it comes to EGWPs are as follows:

  • Your insurance coverage requirements. Take into account the drugs you use and the physicians you visit.
  • This will allow you to determine if the plan covers your drugs and providers.
  • The plan’s geographical scope. Look for hospitals and medical practices that are part of the network.
  • If you need immediate care, look for an in-network hospital near you.
  • The star rating of the plan. The Medicare Advantage Star rating program assigns a star rating to Medicare Advantage plans on a scale of one to five. Plans with four or five stars are considered high-quality by Medicare Advantage.

Because insurance firms design EGWPs for each business, union, or government organization, you may be able to conduct the majority of your study through the insurance company that supplies the plan and your employer’s benefits office.

The Takeaway
Employees may find group Medicare Advantage plans (also known as EGWPs) to be an appealing perk. Joining your company’s EGWP may allow you to receive additional advantages that standard Medicare Advantage does not provide, as well as avoid having to adhere to the same requirements governing enrollment periods.
Check with your previous job to see whether they provide an EGWP. It may save you money in the long term, particularly if your old company covers some of the plan fees.