Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.... covers Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.... health services, which does not include gym memberships or other types of fitness services. That’s a shame because regular exercise benefits overall health, both physical and emotional. Fortunately, many private Medicare plans do cover fitness programs such as the popular SilverSneakers.
In this MedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer.... article, we’ll go over how some private plans provide gym membership benefits.
- A consistent exercise routine can help you improve your health and mood, as well as reduce your risk of certain health conditions.
- Gym memberships at popular U.S. gyms average around $50 a month.
- Medicare does not cover gym memberships because it is not medically necessary to go to the gym.
- Even SilverSneakers is only available as a Medicare plan benefit, not a Medicare-approved service.
- Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... can have gym memberships as an expanded benefit of being a member, although this varies from plan to plan.
- Private insurance companies that sell Medigap policies sometimes include gym memberships as a separate benefit for purchasing through them.
Why Are Exercise and Training Important?
Because through consistent training with a combination of anaerobic and aerobic exercise, you are able to improve all aspects of your health and wellness that do not require a health care professional. By training your body a few hours a week, you can benefit from:1NHS.UK, ”Benefits of exercise”, Accessed December 22, 2021
- Increased balance, mobility, and coordination
- Reduced joint pain and arthritis inflammation
- Increased bone density and reduced risk of osteoporosis
- Increased lean body mass and a leaner body fat percentage
- Reduced risk of heart disease and stroke
- Reduced stress and depression
- Reduced risk of dementia
There are dozens of different ways to train and become stronger, with many gyms and fitness programs providing coaches and classes that can help you optimize your training time. If you have poor joints for jogging, there are swim classes; If you are disinterested in lifting weights, you can do yoga. The second best workout you do consistently will always be better for your health than the best workout you rarely do.2NHS.UK, ”Physical activity guidelines for older adults”, Accessed December 22, 2021
Gym Membership Cost
When selecting a gym to train at, you will want to weigh the monthly costs against the benefits of the gym, like if they have the equipment or classes you want, how clean they keep the facility, and how crowded the gym is during the time you want to train. Some gyms will also offer discounted prices if you purchase a membership for several months or a full year. Here is a list of popular U.S. gym chains and how much their memberships cost per month:3Menshealth.com, “The 10 Best National Gym Chains to Join in 2021”, Accessed December 22, 2021
- Gold’s Gym, $25/month
- Anytime Fitness, $30-$40/month
- 24 Hour Fitness, $30-$40/month
- LA Fitness, $30/month
- Crunch Fitness, $9.95/month
- Blink Fitness, $26/month
- Equinox Fitness Club, $200/month (high-end gym)
Why Doesn’t Medicare Cover Gym Memberships?
The Original Medicare program (Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care.... and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare...) was created to help people ages 65 and over, and people with certain disabilities, get access to affordable major medical care, which does not include physical fitness. You can live for quite some time without having stepped foot in a gym or even done a single push-up. That said, many Medicare Advantage plans recognize the benefits of regular exercise and include gym benefits in their plan.4Medicare.gov, “Gym memberships & fitness programs”, Accessed December 22, 2021
What About SilverSneakers?
While SilverSneakers is a popular fitness program designed for people age 65+ that’s included with many Medicare plans, it is not covered under Original Medicare. However, SilverSneakers is a free benefit available to members of certain Medicare Advantage Plans, that can:5Silversneakers.com, “SilverSneakers”, Accessed December 22, 2021
- Participate in live online fitness classes.
- Access a library of prerecorded workouts.
- Take fitness classes designed for seniors and led by trained instructors.
- Use thousands of participating gyms and community centers across the nation.
SilverSneakers help you stay strong in body, mind, and spirit. If you have a chronic condition, safe exercise can help you feel better. Plus, in-person classes help you remain social, which is vital to good health.5Silversneakers.com, “SilverSneakers”, Accessed December 22, 2021
How Does Medicare Advantage Cover Gym Memberships?
In addition to covering the same services as Original Medicare (Part A and Part B), many Medicare Advantage Plans will offer expanded benefits to their members, such as dental and vision coverage 6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 22, 2021. One of these benefits can include a gym membership through SilverSneakers. You will have to check with the Medicare Advantage plan providers in your area, as not every plan offers the same expanded benefits 4Medicare.gov, “Gym memberships & fitness programs”, Accessed December 22, 2021. However, considering SilverSneakers is available in over 15,000 fitness center locations across the continental U.S., you are likely to find a Medicare Advantage Plan in your area that includes it 5Silversneakers.com, “SilverSneakers”, Accessed December 22, 2021.
Be aware that while Medicare Advantage Plans will cover the same services as Original Medicare, the Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.... can vary. You would also be restricted to using Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... providers for your non-emergency medical services.6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 22, 2021 If you want to avoid private insurance by staying in Original Medicare but also have the benefit of a covered SilverSneakers program, you should consider looking at certain Medigap policies in your area.
Medigap and SilverSneakers
Officially, Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage.... insurances (Medigap) are available for purchase to help you with out-of-pocket costs for Medicare-covered services. Since Original Medicare and Medigap are in lock-step with each other, Medigap plans themselves do not cover any gym memberships because Medicare does not either. Normally, that would be the end of it.7Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?”, Accessed December 22, 2021
However, many insurance companies that sell Medigap policies include coverage for a gym membership as an added benefit for purchasing from them. So if you have Original Medicare and you want coverage for a gym membership such as SilverSneakers, consider shopping for a Medigap plan in your area that offers it. Not only would you get that gym membership, but you will also have all the benefits of purchasing a Medigap plan.8Silversneakers.com, “Participating Health Plans”, Accessed December 22, 2021
Note: many private insurance companies that have a Medicare Advantage Plan with gym membership coverage will also sell a Medigap plan with one as well.
Whether you are able to get it covered or not, you should make it a point to get some exercise a few hours per week. It is an investment in your body’s health and independence against atrophy. If you want to have your gym membership covered by Medicare, you’ll have to look at the Medicare Advantage Plans and Medigap policies in your area to see what they offer. If you are interested in the SilverSneakers fitness program, you can check out their website here to see if a Medicare plan in your area has it as a benefit.
- 1NHS.UK, ”Benefits of exercise”, Accessed December 22, 2021
- 2NHS.UK, ”Physical activity guidelines for older adults”, Accessed December 22, 2021
- 3Menshealth.com, “The 10 Best National Gym Chains to Join in 2021”, Accessed December 22, 2021
- 4Medicare.gov, “Gym memberships & fitness programs”, Accessed December 22, 2021
- 5Silversneakers.com, “SilverSneakers”, Accessed December 22, 2021
- 6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 22, 2021
- 7Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?”, Accessed December 22, 2021
- 8Silversneakers.com, “Participating Health Plans”, Accessed December 22, 2021