Medicare is a federal health insurance program for people who are 65 years or older, certain younger people with disabilities, and folks with end-stage renal disease. As a federally funded social insurance program, Medicare was originally created to provide protection against healthcare costs to U.S. citizens over the age of 65.
Today, there has been an increase in the number of younger people who Medicare covers, and this has been credited to the rise in the aging population of baby boomers.
The monthly premiums and annual deductibles for Medicare depend on what plan you choose (there are four types: A, B, C, and D). Once you enroll in a plan, there is no limit to how many times you visit the doctor in a year. However, there is a limit on the number of outpatient visits and medical procedures that can be attended to per year. You also need to bear in mind that Medicare only covers 80% of your outpatient services, with the remaining 20% being paid by yourself (i.e., out-of-pocket cost).
You are also required to pay a yearly deductible before Medicare can cover your expenses according to www.clearmatchmedicare.com. Depending on the type of plan you have, this deductible may be waived after retirement age. Your monthly premium is also based on which plan you choose among the four available types of plans.
Does Medicare Cover a Fitness Center Membership?
So, does Medicare cover a fitness center membership? Medicare covers fitness center memberships if the membership is part of a rehabilitative program prescribed by your attending physician after certain services or surgeries. For example, you may be eligible for Medicare coverage if you had foot surgery and must use an exercise program to lessen the chance of re-injury. If you are not in any special health care program, Medicare does not cover fitness center memberships.
Fitness Memberships and Part B Coverage
Medicare part B covers 80 percent up to $100 a month for certain medical equipment such as hospital beds and wheelchairs. Fitness center memberships are not covered under this provision. For example, if you paid the entire monthly fee out-of-pocket, Medicare would reimburse 80 percent of your payment up to the $100 limit.
Who Pays for Fitness Center Memberships Not Covered by Medicare?
You are responsible for any portion of a fitness center membership not covered by insurance or other sources. For example, if you have Medicare part A, which covers hospital stays but does not cover your fitness center membership, you are responsible for 100 percent of the monthly fee.
If you have a Medicare plan that does not cover fitness center memberships, such as Medicare part C or D, then you must pay for your membership entirely out-of-pocket.
Is it hard to find a SilverSneakers location?
Unfortunately, despite the growing popularity of fitness center memberships, finding an available spot can be challenging. The good news is that you don’t have to go anywhere if you’re using the SilverSneakers program because it works with most plan providers.
The SilverSneakers program is designed to support arthritis patients, and it works with many insurance companies. Check if your plan provider participates in the SilverSneakers program before joining a fitness center.
Health Insurance through Your Employer May Cover Fitness Center Memberships
If your employer’s health insurance plan offers coverage for fitness center memberships and you sign up for the coverage, you may pay a small monthly fee for the service. Depending on your employer and specific plan, the monthly fee may be very affordable. For example, if you belong to a gym that charges $10 per month for employees of ABC company and $20 for non-employees, your employer’s health insurance would probably cover the lower rate.
What to Do if You Are Denied for Medicare Coverage
If your doctor prescribes an exercise regimen, fitness center membership, or other equipment that Medicare does not cover, you may appeal the decision by submitting a letter of medical necessity. For example, you could explain why your doctor’s prescribed program includes a gym membership when all other alternatives are considered. Your letter should include:
- Your doctor’s name and phone number.
- A list of all other treatment options considered for your specific case.
- A detailed breakdown of the costs that would have been involved with each option.
- A list of all other treatment options considered for your specific case.
- A detailed breakdown of the costs that would have been involved with each option.
If you appeal your denial, Medicare will conduct an internal review to determine if it can cover the cost under a different provision before forwarding the appeal to an independent review organization. This process may take several months to determine the appeal’s outcome.
Getting Help with Your Fitness Center Membership Appeal
The appeal process can be time-consuming and frustrating, especially if your doctor prescribed a fitness center membership that Medicare has denied coverage for. If you consider appealing your denial, consider hiring a health insurance advocate or medical billing advocate to help you with the process. A professional advocate can ensure that all necessary steps are taken, follow-up on your appeal, and let you know how long it may take for your denial to be reversed.
Protecting Your Medicare Benefits
If you have Medicare but are not sure if your membership is covered under one of its provisions, you may wish to consult a professional before joining a fitness center. If you have an advocate on your side from the beginning, they can help you avoid any catastrophic financial issues that could result from paying for services out-of-pocket. Additionally, if your membership is denied and you want to appeal the decision, hiring a professional can increase your chance of a successful appeal.
The cost of fitness center memberships and other medical equipment not covered by Medicare can add up quickly, and the appeals process is time-consuming and frustrating. If you are considering joining a fitness center for the first time, or if you want to appeal a denial of coverage for an existing membership, consider consulting with a professional who can make sure your membership is covered and help you navigate through the appeals process.