Coverage for gym memberships under Medicare isn’t simple. Medicare recipients may qualify for certain benefits, depending on their coverage. The Centers for Disease Control maintains that exercise positively affects physical and emotional health. Staying fit is essential for seniors who may not exercise daily. A comprehensive exercise regimen includes joint function and flexibility, strength training, and aerobics. These exercise plans require special equipment available in fitness centers or gyms.
Medicare Coverage for Special Circumstances
Medicare Parts A and B, or Original Medicare, don’t cover memberships to fitness centers or gyms. If you only have Parts A and B, you have to pay all the out-of-pocket costs for membership to a gym. However, coverage may be available for specific fitness options under Medicare Advantage Plans or Medigap. Original Medicare doesn’t provide coverage for gym memberships. However, some fitness benefits may be covered under Medicare in certain circumstances. For example, you may have coverage for some fitness benefits if considered a medical necessity.
Diabetes Prevention and Management May Be an Option
Programs to prevent or manage diabetes focus on controlling weight through diet and exercise. To avoid diabetes, the Medicare Diabetes Prevention Program covers group sessions that meet weekly for six months. The sessions focus on weight management counseling, diet, nutrition therapy, and exercise. Lifestyle coaches work with participants to gradually increase exercise levels and help keep glucose levels under control.
Physical Therapy Coverage is Available With Certain Plans
Medicare may provide physical therapy following a stroke, a fall, or an accident. Medicare Part A may cover physical therapy at an in-patient rehab hospital or an outpatient facility with a gym. Depending on your plan, you may be eligible for in-home physical therapy to strengthen muscles, improve balance, and restore mobility.
Medicare Part B will pay for outpatient physical therapy after the yearly deductible is met. However, the treatment must be at an outpatient rehab facility, a doctor or therapist’s office, or a hospital outpatient therapy department. Physical therapy may be administered at home with a certified Medicare provider if Part A doesn’t provide at-home care.
How Medicare Advantage Differs from Original Medicare
Under a Medicare Advantage Plan, you’re eligible for all the benefits available under original Medicare. However, depending on the plan you choose, one of the benefits may be coverage for a membership to a gum. The annual premium still applies, but most Medicare Advantage plans feature a co-pay for services. The payment can vary depending on the provider. Out-of-pocket expenses are lower, and fees are capped under Medicare Advantage plans.
How Fitness Benefits Work Under Medicare Advantage Plans
Part C or Medicare Advantage may provide a fitness option. A plan may cover at-home exercise, physical therapy, or membership in a gym. A fitness plan under Medicare is an excellent way to improve physical and mental health. Depending on the option you qualify for, a fitness membership may include transportation costs, at-home exercise plans, or a gym membership.
What Do Gym Memberships Under Part C Cover?
One of the most popular fitness programs that Medicare Advantage covers is Silver Sneakers. The program offers members access to nationwide gyms and fitness centers, gym equipment, and fitness programs. No cost is involved for members who enroll in Medicare Supplement or Medicare Advantage plans. One of the advantages of the Silver Sneakers gym membership is online fitness classes. Instructors work with all levels, no matter your physical limitations. Fitness classes are on-demand to suit your schedule.
Although Silver Sneakers is a popular option under Medicare Advantage Part C plans, there are various options, depending on your provider. To get coverage for a gym membership under Medicare, you must be eligible for Medicare, be at least 65, and enroll in a Medicare Advantage Plan that offers a fitness plan.
At-Home Fitness Plans Are an Option
Working out at home may be an option, depending on your Medicare Part C Plan. Some plans offer at-home workout kits if you choose to avoid signing up for a gym membership. Available alternative resources are fitness equipment, instructional guides, and apps to stream workouts on a smart device.
How Does Medicare Enrollment Work?
Medicare has a variety of coverage options. If you want to add a Medicare Part C plan, you must be enrolled in Medicare Part A and B. You must be a resident in the service area the plan covers. The amount you must pay for the plan depends on the amount of the deductible, the co-payment, and co-insurance. When the deductible and other fees are paid, you don’t have any further charges for the remainder of the year.
If you have a Medicare Advantage Plan, you can make changes during Special Enrollment Periods or under special circumstances that include:
- You have a change of address.
- You’ve left your current plan or lost coverage.
- Your plan’s coverage with Medicare changes.
- You’re eligible to enroll in a different plan.
- To make changes you can contact Medicare or your current area provider.