Modular 2 - Medicare Advantage Employer/Union Plans Flashcards
What are the Medicare Advantage Employer/Union Plans?
Employers and Unions may offer their retirees and their dependents:
- Medicare Advantage individual plans (plans open to the public).
- Medicare Advantage plans that are only available to individuals based on their employer, known as Employer Group Waiver Plans or EGWPs.
- A Medicare Advantage plan through a direct contract between the employer or union and CMS, known as a direct contract plan.
Employers with less than 20 employees (as calculated under Medicare secondary payor rules) may be able to offer Medicare Advantage plans to their active employees and their dependents.
– Any size employer can offer Medicare Advantage plans to its retirees and their dependents.
Can Employer Group Waiver Plans (EGWPs) be any type of Medicare Advantage Plan?
Yes. Employer Group Waiver Plans (EGWPs) can be any type of Medicare Advantage Plan (HMO, PPO, PFFS, or MSA).
Art Employer Group Waiver Plan different than other Medicare Advantage plans?
Yes. These plans are different than other Medicare Advantage plans because eligibility to enroll is limited and because a variety of regulatory requirements are waived as they apply to EGWPs. For example, certain marketing and enrollment requirements do not apply to EGWPs.
