Fact Sheet

Medicare Advantage Employer Retiree Plans

Over three and a half million beneficiaries are enrolled in Medicare Advantage Employer-Group Waiver Plans (EGWPs), which are employer-sponsored health plans for retirees that provide health coverage through the Medicare Advantage program. 

Key Facts:

Over 3.5 million retirees nationwide, 20% of Medicare Advantage beneficiaries, are in EGWPs. Retiree enrollment continues to grow, nearly doubling since 2010.

• Medicare Advantage employer plans provide the following benefits to retirees:

• Comprehensive Medicare coverage as well as supplemental benefits such as vision, hearing, and dental.

• Access to providers nationwide.

• Lower premiums and limits in out-of-pocket costs.

• Improved outcomes.

A continued reduction in payment to retiree Medicare Advantage plans will likely cause:

• Higher premiums and out-of-pocket costs for medical services and prescriptions.

• Reduced access to supplemental benefits.

• Reduced investments in innovations.

Policy Recommendation:

Better Medicare Alliance supports ensuring the availability of EGWPs by freezing the implementation of the new payment methodology and calculating bid-to-benchmark ratios separately for Health Maintenance Organizations (HMO) and Local Preferred Provider Organizations (PPO) plans. CMS should also engage in greater promotion of EGWPs by targeting informational materials and outreach to entities that represent eligible beneficiaries, private employers, and state and local governments.