Although improved fitness plays a significant role in improving overall health and reducing your risk for disease, Original Medicare rarely covers the cost of exercise classes or the services of a personal trainer or exercise therapist. However, in a small number of cases, Medicare Part B may cover occupational and physical therapy, which could include some exercise and fitness training. This coverage only applies if your physician specifically prescribes the therapy.
Part B Physical and Occupational Therapy
Medicare Part B helps pay for physical and occupational therapy deemed medically necessary by your doctor. He or she must prescribe and regularly review the therapy, which must be provided by a Medicare-certified therapist on an outpatient basis.
Part B pays 80 percent of the Medicare-approved amount. In 2018, there is no annual cap. However, if the combined total of your physical therapy and speech-language pathology services reaches $2,010, or if your occupational therapy services total reaches $2,010, your therapist must affirm that the services you’re receiving are reasonable and necessary. If your totals reach $3,000, your records may undergo review by a Medicare contractor.
All Part B beneficiaries are covered assuming the services are medically reasonable and necessary. Your Part B deductible applies, and your cost is 20 percent of the Medicare approved amount.
Medicare Advantage Exercise Plan Coverage
Medicare Advantage (MA) plans (also known as Medicare Part C), must offer at least the same coverage as Original Medicare. But, they may also offer extra benefits, including exercise program coverage. Bear in mind that, when you sign up for Part C, you are still part of the Medicare program and must continue to pay your Part B premiums.
MA plans are not obligated to offer exercise program coverage, so you need to research your options to find the right program. You can do this at the Medicare Plan Finder page.
Several private health insurers offer exercise benefits as part of their Part C coverage, including Aetna, Priority Health, HealthPartners, and Humana. The most commonly sought-after fitness programs are Silver&Fit and SilverSneakers.
Silver&Fit Exercise and Healthy Aging Program
This exercise program is ideal for seniors; it works with your lifestyle to ensure you stay fit and active. Visit the Silver&Fit website to find a facility close to you. The benefits vary depending on the MA plan and provider you choose, but offerings include:
- Access to cardiovascular and strength training equipment
- Access to fitness facility amenities, including whirlpools, swimming pools, and saunas
- Fitness facility exercise classes
- Online resources, such as health and wellness centers
If you wish to be fit and healthy but do not want to travel to a facility, or there is no center nearby, you could receive a variety of home exercise kits, including:
- Strength training
- Tai Chi
These kits usually consist of a guide or DVD, making exercising simple and fun. While some providers offer Silver&Fit with no deductibles or copayments, others add a small annual fee of $10 to $25.
This is another extremely popular exercise program that is offered by a host of MA insurers. With approximately 14,000 participating fitness centers to choose from, you’re likely to find a facility near you. Check the SilverSneakers website to determine whether your health plan offers the program as part of its benefits.
Reasons to consider SilverSneakers include:
- Amenities such as swimming pools, saunas, and exercise equipment
- Special classes for seniors run by qualified instructors
- Assistance and guidance from a Program Advisor
- A variety of fun, social activities
The SilverSneakers FLEX option is also a popular choice with seniors. It offers over 50 innovative classes including walking groups, indoor and outdoor boot camp, and dancing.
If you prefer to exercise in the comfort of your own home, the SilverSneakers Steps program is for you. Upon registration, you receive a kit that includes a pedometer, resistance bands, and an exercise DVD. Use these tools to tailor your workout around your lifestyle and individual capabilities.
PHIT stands for Personal Health Improvement Training and it is a special program offered by the Aetna Fitness Program. After registering for SeniorPHIT, you receive two customized wellness plans that teach you how to eat healthily, exercise correctly, and handle life’s challenges. An online coach is available 24/7 to chat, and you can reference thousands of articles and healthy recipes in the program’s online library.
Additional Medicare Healthy Lifestyle Services
Although Original Medicare does not cover gym memberships, it does offer services designed to help you improve your fitness.
One of your Part B benefits is nutrition therapy services. Your doctor refers you to a registered dietician who performs a nutrition and lifestyle assessment, provides nutrition therapy services, and checks your progress during follow-up visits. Eligibility requirements include having Medicare Part B as well as at least one of the following conditions:
- Kidney disease
- Had a kidney transplant in the past 36 months
Your cost for these services is zero as long as the dietician accepts assignment.
Medicare Part B also covers obesity screening and behavioral counseling sessions to help you lose weight assuming services occur in a primary care setting. This is because your counseling must be coordinated with your other care and a personalized prevention plan. If you have Medicare Part B and a BMI of 30 or higher, you qualify. Again, your cost is zero as long as your primary care physician accepts assignment.
Although it offers some services to help you live a healthier lifestyle, Original Medicare does not cover the cost associated with exercise programs for seniors. If you are looking to get fit and active, however, a number of Medicare Advantage plans provide free or low-cost options. Staying in shape ensures you get the most out of your golden years, so look for the right Medicare Part C plan and get active!
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