Public Sector Medicare Advantage EGWPs In a Shifting Landscape:
Challenges, Opportunities, and Policy Considerations

As Medicare Advantage (MA) continues to grow—now serving more than half of all Medicare beneficiaries—public sector employers are increasingly turning to Employer Group Waiver Plans (EGWPs) to provide affordable, comprehensive health coverage for retirees. These specialized MA plans have become a vital tool for managing rising health care costs while ensuring access to high-quality, integrated care.

Public employers, who support essential services like education, public safety, and infrastructure, often carry the long-term responsibility of retiree health benefits. With health care costs on the rise and policy changes underway, the landscape for EGWPs is shifting.

This paper examines the evolving role of EGWPs in the public sector, unpacking key design elements, regulatory trends, and the impact of recent legislation such as the Inflation Reduction Act. It provides actionable insights for policymakers, public purchasers, and stakeholders working to strengthen the long-term sustainability and impact of these plans.