Being in good health and staying active is the best way to live a long and happy life. While some people enjoy getting their exercise in outdoor sports or other activities, many may prefer the more comfortable and stress-free environment of indoor gym to help them maintain a healthy mind and body. This is particularly common among the elderlies or people whose mobility are limited by certain conditions.
Yet with all its benefits, gym fees can be unaffordable to many people, especially to retirees who must watch their budget carefully. This brings us to the question of whether Medicare, the government program created to help older Americans or those with certain disabilities to get health insurance, cover gym memberships or fitness programs. And the answer to that is that it depends, and there's not a simple yes or no answer.
Every Medicare plan is different and may include its own unique benefits. So whether you are covered for fitness center membership or not depends on what Medicare program you currently have. In this blog post, we will go through the ways you can obtain Medicare Gym Memberships.
What is Original Medicare?
Before we get to gym membership coverage, we need to understand the basics of Medicare. Medicare is divided into four parts -- parts A to D. The first two, Part A and Part B, are also known as Original Medicare and together they form the basic or essential parts of the program. While Part A is mandatory for any Medicare plans, all others are optional.
Part A is essentially hospital insurance that covers your hospital bills and other inpatient expenses. It typically pays for the following: hospital stays, hospice care, skilled nursing facility care, and some home health care services. Most people get this coverage without any sort of premiums, as they would've paid into the system with payroll taxes during their working years.
Medicare Part B refers to medical insurance that covers outpatient services such as doctor visits, outpatient care, preventative services, and medical equipment. While Medicare part B usually requires you to pay a monthly premium, it's an optional plan.
So while Medicare Part A and Part B cover a lot of essential services, they do not give you free gym memberships directly. That said, they do sometimes offer things like physical therapy, group therapy for diabetes prevention, and nutrition therapy, though they only apply to people suffering certain conditions.
Is there any Medicare Plan that Covers Gym Memberships?
As Original Medicare doesn't pay for gym memberships, what about other Medicare health plans? Medicare Advantage plans, which are the type of Medicare insurance plan offered by private insurance companies instead of the government, could be your answer. These plans typically offer additional benefits outside of what Part A and Part B include.
Medicare Advantage plans are also known as Medicare Part C. If you're looking for a Medicare plan with gym and fitness benefits, this may be the right choice for you.
Enrolling in Medicare Advantage plans?
If you don't have Medicare yet, and you're under 65, you can enroll directly into a Medicare Advantage plan during your initial enrollment period. This starts 3 months before you turn 65 and ends 3 months after your 65th birthday.
But let's say you're over the age of 65, you've have had Medicare for a while, and you want to switch to a plan that covers a gym membership. In that case, you can enroll during the open enrollment period, which is every year from October 15th - December 7th. When you enroll during this time, your coverage starts January 1st of the following year.
What To Consider With Medicare Advantage Plans
Medicare Advantage plans typically offer extra benefits such as prescription drug coverage, dental and vision care, and wellness programs. But before you jump to switch to a Medicare Advantage Plan, there are a few things you need to think about. And the reason is that while many Medicare Advantage Plans cover gym memberships, there are some downsides to them.
For example, most Medicare Advantage Plans have a network of doctors and healthcare providers that members must use to receive coverage for medical services. So if you have a preferred doctor or healthcare provider, you should check to make sure they are covered by your insurance company.
Also, some plans may require authorization for certain preventive services or medications. This can sometimes cause delays in your treatment, and also allows your insurance company to refuse the medicine you may need.
With Original Medicare, all of your healthcare decisions stay between you and your doctor, not an insurance company. In addition, you also have the flexibility to visit any doctor, hospital, or skilled nursing facility in the country, without having worry about whether they're covered by your plans.
Medicare Supplement Insurance
Medicare is a very helpful tool for those over 65, or with qualifying conditions. But for some people, it can get quite tiring to have to deal with tall he copays, coinsurance, or deductibles that come with Original Medicare. Medicare Advantage Plans, on the other hand, normally offer a variety of options when it comes to out-of-pocket expenses.
The Part A deductible for 2023 is $1,600 per benefit period. A benefit period starts when you are admitted to a hospital or skilled nursing facility and ends 60 days after you are discharged. That means that once you pay the first $1,600 of your hospital bills, you can get all the inpatient treatment you want, fully covered by Medicare.
The Part B deductible is a bit different. This one works on a yearly basis, and is $226 for 2023. So if you have Medicare, you typically will never have to pay more than that year's deductible for Part B covered services each year.
Medicare Supplement Insurance (or MediGap) is a supplemental program that essentially helps you pay for these deductibles, as well as copays and coinsurance. So if you qualify for MediGap, you can cut some costs that come with Original Medicare. Note that while MediGap plans may have higher monthly premiums, if you expect a lot of medical expenses, it could still be a money-saving program for you.
What About The SilverSneakers Fitness programs?
There is another option that would allow you to keep the Medicare Original plan and go to the gym for free. The SilverSneakers fitness program offers completely free access to gym memberships and fitness benefits for qualifying seniors who are enrolled in qualified Medicare Advantage plans or MediGap. They are available in thousands of locations including gyms, fitness centers, and senior living communities.
SilverSneackers will pay for things like sports equipment, saunas, swimming pools, free weights and machines, fitness classes, and more. The program was created to promote health and fun activities among senior individuals. You can check if you qualify from the SilverSneakers website in a matter of seconds.
We Are Here to Make it EASY for You?
Are you finding these information a bit hard to navigate? Don't worry, we are here to help
At EASY Insurance, we have a team of experienced agents that are dedicated to helping you find the health plans that best suit your needs. Whether your interest is best served by options offered by the government or private insurance providers, they are always happy to take the time to sit down and discuss them.
We're here to get you on the right track to living a healthy and EASY life.