Does your employer health plan cover gym memberships and other wellness benefits? If so, you’re probably hoping to get similar benefits from your Texas Medicare plan. After all, you don’t want to give up on your healthy fitness routines.
For Texas Medicare enrollees, there’s good news and bad news. The bad news: Original Medicare doesn’t cover gym memberships. The good news: Many Texas Medicare Advantage plans do include the SilverSneakers program or other fitness benefits. Here’s a look at your options.
Does Medicare cover any exercise programs?
If you’re a healthy senior just trying to keep fit, don’t look to Original Medicare to pay for a class at the Y. However, if you’re a heart patient—someone who’s had a heart attack or bypass surgery, for example—Original Medicare may pay for an outpatient cardiac rehab program. These programs typically involve aerobic exercise and other activities to help keep you heart-healthy. Medicare pays for 36 one-hour sessions.
If you want access to fitness classes, a pool, and other gym perks, Medicare Advantage and Medigap may be the only way to go. Not all Texas Medicare Advantage and Medigap plans include gym memberships, but chances are good you’ll find one in your area that does.
The SilverSneakers program is popular with many Texas seniors. If your Medicare plan includes SilverSneakers, you get a free basic membership to any gym or fitness facility that participates. You can use this link to check for Texas gyms that participate in SilverSneakers. There are over 14,000 facilities open to SilverSneakers members, and you can use your membership at any participating gym in the country.
Even if a plan doesn’t include SilverSneakers benefits, it may offer discounted memberships at participating gyms or pay a set amount toward membership at the gym of your choice.
It’s important to note that UnitedHealthcare recently announced that it’s dropping SilverSneakers from its Medicare Advantage and Medigap plans in certain states. Texas is currently not on the list, but the company may make additional changes in the future, and its decision may influence other insurers, as well. UnitedHealthcare hasn’t cut fitness benefits completely, however. It is replacing SilverSneakers with its own package of wellness and fitness benefits, which include access to 7,000 participating gyms.
How can I find a Texas Medicare plan that covers gym memberships?
Both Medicare Advantage and Medigap are private insurance plans. Each insurance company offering these plans chooses which benefits it will offer and how much it will pay for these supplemental benefits. In other words, there’s no rule saying Texas Medicare plans must include gym memberships.
If covered gym memberships and other wellness benefits are important to you, you need to start your research well before your initial enrollment period or annual election period. Find out which plans are available in your area and compare premiums and benefits. Remember that you must continue to pay your Part B premium every month plus the monthly premium charged by your plan.
Because these are private plans, the insurance companies determine what to charge. Premiums aren’t standardized by the government as they are for Part A and Part B. Figure out what you would pay for a gym membership at the YMCA or your favorite gym, and then compare the premiums for plans with and without fitness benefits. If the difference in premiums is higher than the monthly cost for a gym membership, go with the cheaper plan and pay out-of-pocket.
You should never base your Medicare decision solely on one particular benefit or another. Texas Medicare plans can and do change their benefits and premiums on a regular basis, so you can’t count on a free gym membership for life if you choose a certain plan. This is especially important if you choose Original Medicare and a Medigap plan. You have the opportunity to change your Medicare Advantage plan twice a year during the Annual Election Period and the Medicare Advantage Open Enrollment Period. There is no such option with Medigap.
Most people only have one opportunity to buy Medigap without answering questions about their health status and past medical history. If you buy Medigap during your Medigap Open Enrollment Period, you can buy any plan sold in Texas at the lowest available premium. Outside that period, you can be turned down based on your health status. Locking yourself into a Medigap plan just for the gym membership would be a very short-sighted decision.
It’s hard to transition from a generous employer health plan to Medicare, especially if you’ve grown to love your perks. Fortunately, you can still get the coverage you want if you comparison-shop your Texas Medicare plans. Contact a licensed Texas Medicare broker to help you navigate your coverage options.