Whipping Egg-Whips: Retirees Are Winning Battles Against Medicare Advantage
An advocate holds a sign during a news conference on Medicare Advantage plans in front of the U.S. Capitol on July 25, 2023 in Washington, D.C. (Photo: Alex Wong/Getty Images)
In a country inundated with ads falsely praising the benefits of MA plans, it is amazing that grassroots organizations have cut through the gibberish, exposed the lies, and are fighting to keep their traditional Medicare with promised supplementary coverage.
by Kay Tillow
An Egg-Whip sounds like a festive, holiday drink or a merengue dessert. It is anything but a delightful treat.
Egg-Whip is the healthcare industry’s name for Employer Group Waiver Plans (EGWP), a provision for privatization of employer-based, retiree Medicare benefits that was written into the Medicare Modernization Act (MMA) of 2003. That law, which House Energy and Commerce Chair Billy Tauzin twisted arms to pass, added a drug plan to Medicare, not by including drugs as covered Medicare benefits, but by compelling seniors to purchase private drug plans. Big Pharma gained a massive influx of government money into its coffers and rewarded Tauzin with a $2-million-a-year job.
That’s what we could see on the surface. Who knew then that hidden in the MMA law was further privatization of Medicare beyond this privatized, publicly-subsidized drug plan known as Medicare Part D.
This other provision in the MMA, the Egg-Whip, allows employers that have committed to provide health benefits for retirees to force those seniors, without their consent, into private, for-profit Medicare Advantage (MA) plans that impose conditions on the promised benefits.
These private employer-based Egg-Whip MA plans are exempt from requirements that individual Medicare Advantage plans must meet. The MA Egg-Whip plans “can set their own enrollment deadlines, send members information without prior CMS approval for accuracy, and follow weaker requirements for provider networks, among other things,” according to Susan Jaffe of Kaiser Health News.
Chris Maikels of Mercer Marketplace, a retiree benefits company, claims that his clients have saved up to 50% by moving retirees into MA private plans. “Employers find Medicare Advantage [plans] appealing because they can drive significant savings,” he asserts.
For the retirees who are forced into Egg-Whips, the results are not so appealing. A private for-profit middleman is placed between the beneficiaries and their physicians. Medicare funds are funneled through these plans. The more the plans limit, delay, and deny care, the greater the profits. The beneficiaries’ interest in care is diametrically opposed to the pecuniary interests of the insurance companies, such as Humana, United Health Care, or Aetna, through which their Medicare benefits are now funneled. Physicians’ decisions can be overruled by the money men who demand prior authorization. The best cancer centers and rehab facilities are off-limits. The network of approved providers may be limited to a geographic region. Doctors come and go from the network. The co-payments will escalate with the gravity of the illness.
Employers who seek the savings of private MA plans hide these detrimental characteristics of Egg-Whips by touting additional benefits like gym memberships, coverage for dental and eyeglasses, no co-pays on some procedures, and more. Those extra benefits are icing on the cake—but there’s no cake underneath.
In a country inundated with Medicare Advantage ads falsely praising the benefits of such plans, it is amazing that grassroots organizations of retirees have cut through the gibberish, exposed the lies, and are fighting to keep their traditional Medicare with promised supplementary coverage.
And they’re winning, too!
The Vermont State Employees Association (VSEA) effectively stopped Governor Phil Scott from moving state retirees to a private Medicare Advantage plan. State officials asserted that such a change would maintain the same level of coverage for retirees and save them an average of 20% on their premiums while saving money for the state of Vermont.