Medicare membership and physical activity: Here’s what’s covered and what’s not

According to the CDC, if you’re 65 or older, your weekly physical activity should include 150 minutes of moderate-intensity exercise, two or more sessions of strength training, and equity promotion activities.

Physical activity is important at any age, especially as we grow older. Exercise helps the body heal faster and prevent injuries, and supports mental health and brain function.

Another way to make exercise easier is to join a gym, which often provides most or all of the activities recommended by the CDC.

For a gym membership in the United States, the average monthly cost is $58. That amount can vary greatly, from $15 per month to several hundred dollars or more per month depending on the location and type of equipment, classes and materials.

In the US, 20% of gym members are 65 and older.

Does Medicare pay for your gym membership?

Medicare coverage of gym memberships may seem like a no-brainer, given the importance of exercise for seniors, right? No.

“Original Medicare doesn’t cover gym memberships,” says Jean Brasher, vice president and Medicare specialist at Brasher Brokerage in Delray Beach, Fla.

Why is that, when exercise offers so many benefits?

“Medicare will not cover health, because it is not related to medical problems,” says Diane Omdahl, author of the book. Medicare for you and co-founder of consulting firm Medicare 65 Incorporated.

Medicare coverage includes medically necessary services and minor preventive services to prevent illness (such as vaccinations) or detect illness early when treatment would be most beneficial.

However, if you are willing to sign up for a Medicare Supplement insurance plan, also known as Medigap, you can get gym memberships and gym coverage.

Medigap plans generally cost $200–$300 per month, depending on the plan and your location, says Brasher. That adds up to your monthly Medicare plan, which is $174.70 a month for most people, with an annual cost of $240. The primary function of Medigap plans is to cover out-of-pocket costs not covered by original Medicare (such as a 20% co-pay and deductible), he says, and exercise coverage is a benefit. more.

At the time of this writing, Brasher said that one insurance provider, United Healthcare, offers Medicare Supplement plans that include a large coverage of gym memberships and exercise groups—which vary by location but may they include pilates classes, water aerobics, stretching sessions and more.

Practice options with this insurance provider are available throughout the US, so if you’re traveling or spending part of the year somewhere else, or want to check out what’s available in your area at zero cost, you can enter your zip code.

Note that you may be limited to the number of monthly classes or hours you can use certain resources.

Medicare Advantage covers gym memberships

This is one area where private Medicare Advantage insurance plans—which can be cheaper than traditional Medicare, but often have limited doctor and hospital networks and require prior authorization— offers more benefits than traditional Medicare, at least in recent years.

“In 2019, CMS [Centers for Medicare and Medicaid Services] He opened the door for Medicare Advantage plans to offer additional health-related benefits,” including exercise-related benefits, says Omdahl.

Today, according to data from the Kaiser Family Foundation, 95% of Medicare Advantage plans offer exercise benefits.

Benefits vary widely, but often include exercise classes and gym memberships, says Brasher, with many of these Medicare Advantage plans offering low monthly premiums.

Some medical expenses are covered by Medicare Advantage

Some Medicare Advantage plans have additional benefits that cover gym expenses beyond gym memberships and classes.

For example, Brasher says, one insurance broker offers a PPO plan that includes an additional $800 deductible. He explains: “You can buy an Apple Watch, skis, camping equipment – there’s a long list of what qualifies as a recreational good.

Medicaid coverage of practice members

Health insurance is not a mandatory type of coverage under Medicaid, but states may offer it.

Free exercise options

Communities often provide free exercise equipment to senior citizens.

Senior centers may offer free health and fitness classes—information can be provided by your local Center on Aging..

A word of caution

While exercise is important, Omdahl recommends looking at the big picture when choosing a Medicare plan.

“We always advise against choosing a Medicare plan for one of these additional benefits,” says Omdahl. “Plans can change, and your needs can change. You must check how the plan will work if you need medical care. ”

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