Employer Group Waiver Plans (EGWPs)
This page provides important information on Employer Group Waiver Plan (EGWP) coverage under Medicare Parts C and D. Chapter 12 of the Prescription Drug Benefit Manual covers EGWPs from a Part D perspective; for comparable Part C information please consult Chapter 9 of the Managed Care Manual (MCM).
EGWPs are expected to follow all Parts C and D requirements except those that are explicitly waived. Below we provide an October 29, 2008 list of Part D waivers, as well as memos discussing additional waivers. For a list of waivers related to Part C, please see Appendix 2 to Chapter 9 of the MCM.
Please check back, as we will continue to update this page.
Note: CMS sponsors a quarterly Employer Open Door Forum call, with an emphasis on communicating and discussing Medicare and Small Business Health Options Program (SHOP) issues to the employer community for the benefit of their organizations, employees, and retirees. These calls may from time to time cover Medicare Part C and D EGWP topics; interested stakeholders may sign up on the applicable website in Related Links below.
EGWP User Call Presentation - Material and Transcript (v11.06.13) (ZIP)
Update on Employer Group Waiver Plan (EGWP) Supplemental Benefits and Coverage Gap Policies for 2013 and 2014 (v01.25.13) (PDF)
Limited Waiver available to Part C and D Plans under CMS sanction to permit enrollment of Employer Group Health Plan Retirees (v02.17.09) (PDF)
Permitting Employer/Union Sponsors to Enroll Beneficiaries in Both an “800 Series” Local MA-Only Coordinated Care Plan and an “800 Series” Standalone PDP (v07.23.07) (PDF)
Update to Parts C and D Employer Group Waiver Plan (EGWP) Waivers - Revised (v02.23.11) (PDF)
Part D EGWP Waivers (v10.29.08) (PDF)