Does Medicare Cover Gym or Fitness Programs?

Medicare generally does not cover gym or fitness programs directly. Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), focuses on medically necessary services. Many Medicare Advantage plans, offered by private insurance companies, do provide fitness benefits as a supplemental offering. These plans often include access to gyms or specialized wellness programs.

Original Medicare and Fitness Coverage

Original Medicare does not pay for gym memberships or general fitness programs. Part A covers hospital and skilled nursing care, while Part B covers doctor services, outpatient care, and preventive services. General health and wellness programs, such as gym memberships, are not considered medically necessary services under Original Medicare.

If a doctor prescribes physical therapy or rehabilitation services for a specific injury or illness, Part B may cover these services. This coverage is distinct from a general gym membership, as it is tied to a medical diagnosis and a specific treatment plan. For example, Part B may cover group sessions for diabetes prevention or weight-loss counseling for individuals meeting specific body mass index (BMI) criteria, which are targeted medical interventions, not broad fitness benefits.

Medicare Advantage Plan Benefits

Medicare Advantage plans, also known as Part C, are offered by private insurance companies. These plans are required to cover all the same services as Original Medicare Parts A and B. Many Medicare Advantage plans also provide supplemental benefits, which can include coverage for gym memberships or fitness programs. These benefits are designed to encourage overall health and wellness among beneficiaries.

Common fitness programs associated with Medicare Advantage plans include SilverSneakers and Renew Active. SilverSneakers offers access to a network of thousands of fitness locations across the country, as well as online classes and on-demand videos. Renew Active, offered by certain Medicare Advantage plans, provides gym memberships, online brain health programs, and social wellness activities. The specific fitness benefits available vary depending on the individual plan, the insurance company, and the geographic location.

Finding and Using Fitness Programs

Beneficiaries can determine if their plan covers fitness programs by reviewing their Medicare Advantage plan’s Summary of Benefits or Evidence of Coverage. Individuals can also contact their plan directly by calling the member services number on their insurance card to inquire about “fitness benefits” or “wellness programs”.

Once coverage is confirmed, accessing these benefits involves using a membership ID or confirmation code provided by the plan. This ID or code can be presented at participating gyms or fitness centers to gain access. Some plans may also offer at-home fitness options, such as online classes, workout apps, or home fitness kits, in addition to traditional gym access.