If exercise is so healthy, why doesn’t Medicare always cover gym memberships?
A recent report published by the Centers for Disease Control and Prevention shows that many older Americans aren’t getting the recommended amount of physical activity.
According to the CDC, if you’re 65 or older, your weekly physical activity should include 150 minutes of moderate-intensity aerobic activity, two or more muscle-strengthening sessions, and balance-improving activities.
Physical activity is important at any age, and especially as we get older. Exercise helps the body heal more quickly and prevent injuries, and also supports mental health and brain function.
One way to make exercising easier is to join a gym, which typically offers most or all of the CDC’s recommended activities.
To become a member of a gym in the U.S., the average monthly cost is $58. That figure can vary widely, from $15 per month to some that cost several hundred dollars or more per month depending on the location and type of equipment, classes, and amenities.
In the U.S., 20% of gym members are 65 and older.
Does Medicare pay for your gym membership?
Medicare coverage of gym memberships would seem like a no-brainer, given the importance of physical activity for older adults, right? Nope.
“Original Medicare does not 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 cannot cover fitness, because it’s not related to medical problems,” says Diane Omdahl, author of Medicare for You and cofounder of the Medicare advisory firm 65 Incorporated.
Medicare coverage includes medically necessary services and a small range of preventive services to prevent sickness (such as vaccinations) or detect illness early when treatment is most likely to be helpful.
However, if you’re willing to sign up for a Medicare Supplement insurance plan, also known as Medigap, you may get gym membership and fitness coverage.
Medigap plans generally cost $200–$300 per month, depending on the plan and your location, says Brasher. That’s in addition to your monthly traditional plan, which is $174.70 per month for most people, with a $240 annual deductible. The main function of Medigap plans is to cover out-of-pocket expenses not covered by original Medicare (such as the 20% co-pay and deductibles), she says, and fitness coverage is an added benefit.
As of this writing, Brasher says one insurance carrier, United Healthcare, does offer Medicare Supplement plans that do include extensive coverage of gym memberships and fitness classes—varied by location but possibly including pilates classes, water aerobics, stretching sessions, and more.
Fitness options with this insurance carrier are available throughout the U.S., so if you travel or spend part of the year in another area, or want to check what’s available locally at zero cost, you can input your zip code.
Be aware that you may be limited in the number of monthly classes or the hours you can use certain facilities.
Medicare Advantage coverage of gym memberships
This is one area where Medicare Advantage private insurance plans—which can be lower in price than traditional plans, but often have limited doctor and hospital networks and require prior authorizations—clearly offer more benefits than traditional Medicare, at least in recent years.
“In 2019, CMS [Centers for Medicare and Medicaid Services] opened the door for Medicare Advantage plans to offer supplemental health-related benefits,” including benefits related to fitness, says Omdahl.
Today, according to data from Kaiser Family Foundation, 95% of Medicare Advantage plans offer fitness benefits.
The benefits vary widely, but often cover fitness classes and gym memberships, says Brasher, with many of these Medicare Advantage plans offering zero-cost monthly premiums.
Other fitness expenses covered by Medicare Advantage
Some Medicare Advantage plans have supplemental benefits that cover fitness expenses beyond gym memberships and classes.
For example, Brasher says, one insurance carrier offers a PPO plan which includes an $800 supplemental benefit. “You can buy an Apple Watch, skis, camping equipment—there’s a long list of what qualifies as a recreational benefit,” she explains.
Medicaid coverage of gym memberships
Fitness coverage is not a mandatory type of coverage under Medicaid, but states may offer it.
Free fitness options
Communities often provide free fitness resources to older residents.
Senior centers may offer free health and fitness classes—information on which may be provided by your local Area Agency on Aging.
A word of caution
While fitness is important, Omdahl recommends looking at the big picture when choosing a Medicare plan. “We always advise not to pick a Medicare plan for one of these supplemental benefits,” says Omdahl. “Plans can change, and your needs can change. You have to look at how the plan will work when you need medical care.”
