Insurers See Opportunities in EGWPs as MA Program Grows

From RADAR on Medicare Advantage

Nearly 4.2 million out of 21 million total Medicare Advantage beneficiaries are currently enrolled in an Employer Group Waiver Plan (EGWP), with enrollment in these group retiree options rising by double-digit percentages in the last couple of years. HealthScape Advisors LLC advises many of its clients to consider tapping this “untapped” EGWP opportunity.

EGWPs offer plan sponsors certain flexibilities that are not available with individual MA coverage, and regional plans are in a prime position to compete with larger carriers due to their local relationships, according to Cary Badger, principal with HealthScape. Yet, what’s often held regional plans back from sponsoring EGWPs is a host of operational considerations and a required set of core competencies that are separate from individual MA.

HealthScape helps its clients to create an “administrative bridge into the group market,” Badger says. The value proposition for employers, he adds, is the documented efficiencies that come with managing the cost of the benefits, which cannot be achieved with traditional fee-for-service Medicare.

Brian Eck, associate vice president of sales for insurer UCare, points out that one of the key differences between administering individual MA plans and EGWPs is that the plan materials can vary by employer and group materials do not need to be approved by CMS.

Another advantage of EGWPs is that insurers know more about the risk profile of the group (in advance) because the employer/union has a better idea of who will be covered than individual plans, according to Badger.

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