Original Medicare vs. Medicare Advantage and Medigap Plans
When seeking to understand how the SilverSneakers program works, it is crucial to distinguish between different types of Medicare coverage. This is the source of much confusion for beneficiaries.
Why Original Medicare doesn't cover fitness programs
Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), is the government-run program that covers hospital stays, doctor's visits, and certain medical supplies. However, it generally does not cover services or items considered non-essential to medical treatment, and unfortunately, gym memberships and fitness programs fall into this category. If you only have Original Medicare, you must pay for fitness programs out-of-pocket.
How Medicare Advantage and Medigap provide coverage
Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans provide all of the benefits of Original Medicare and are required to cover at least the same services. However, many of these plans offer extra benefits, including dental, vision, hearing, and, crucially, fitness benefits like the SilverSneakers program. For eligible members, the SilverSneakers membership is included at no extra cost beyond the plan's regular premiums, deductibles, and copayments.
Likewise, some Medicare Supplement Insurance plans, or Medigap, may also include gym membership benefits. These private plans are designed to help cover some of the out-of-pocket costs that Original Medicare doesn't pay. Some Medigap insurers include fitness program access as a bonus benefit, but this varies significantly by plan and location.
Your Costs for a SilverSneakers Membership
For those enrolled in a Medicare Advantage or Medigap plan that offers SilverSneakers, the membership itself is typically provided at no additional cost. The insurance company pays the fees directly to the SilverSneakers program. This includes access to:
- Participating fitness centers and gyms.
- Senior-focused fitness classes, such as yoga, strength training, and balance.
- The online SilverSneakers LIVE platform, offering virtual classes and workshops.
- On-demand workout videos and educational content.
- FLEX community-based classes held in parks and local venues.
It's important to remember that while the SilverSneakers membership is "free" with your plan, you are still responsible for the plan's overall costs. These can include:
- Monthly premiums for the Medicare Advantage or Medigap plan.
- Annual deductibles.
- Copayments or coinsurance for doctor visits and other services.
Moreover, the SilverSneakers membership only covers the basic access and classes. Any extra-cost amenities offered by a gym, such as personal training, massage, or tanning services, are not included and must be paid for separately out-of-pocket.
Checking Your Eligibility and Finding a Plan
If you're interested in the SilverSneakers benefit, checking your eligibility is straightforward. You must be eligible for Medicare, which generally means being 65 or older, and you must be enrolled in a participating private Medicare plan. The best way to check is to:
- Visit the SilverSneakers website: Use the eligibility tool on their site by entering your Medicare details. This is the fastest and most direct method to confirm if your current plan is included. (Check your eligibility here.) The site will also help you find participating locations nearby.
- Contact your insurance provider: Call the number on your insurance card and ask a representative if your specific plan includes the SilverSneakers program.
- Review your plan documents: The Evidence of Coverage (EOC) document provided by your insurance company details all covered benefits, including supplemental ones like fitness programs.
Comparing Fitness Programs and Medicare Plans
While SilverSneakers is a widely known fitness program, it is not the only one available through private Medicare plans. It is wise to compare your options, as not all plans offer the same benefits. Some popular alternatives include Renew Active (offered by UnitedHealthcare) and Silver&Fit.
| Feature | SilverSneakers | Renew Active | Silver&Fit |
|---|---|---|---|
| Availability | Wide network of gyms and community centers. | Select UnitedHealthcare plans. | Offered by various health plans, including some Medicare Advantage. |
| Core Benefit | Free access to participating gyms and classes. | Free access to gyms, brain health program, social events. | Network of gyms, home fitness kits, online resources. |
| Eligibility | Qualifying Medicare Advantage or Medigap plan. | Specific UnitedHealthcare plans. | Qualifying Medicare Advantage, Medigap, and group retiree plans. |
| Online Access | SilverSneakers LIVE and on-demand videos. | Online brain health resources and workout videos. | Home fitness options and digital workout library. |
| Flexibility | Access to any participating location nationwide. | Varies by plan, often broad access. | Varies by plan. |
When choosing a plan, experts advise against selecting one solely for a single extra benefit like a fitness program. Your primary focus should be on ensuring the plan meets your comprehensive medical needs. Benefits can also change annually, so what's included one year might not be the next.
Conclusion: Your Path to an Active Senior Lifestyle
In summary, Medicare does not pay for SilverSneakers directly. The cost is covered by private insurance companies offering Medicare Advantage and some Medigap plans. For those with a qualifying plan, the SilverSneakers membership is a cost-effective way to stay active, providing access to a wide network of gyms, classes, and digital resources without additional membership fees. To confirm eligibility and understand potential costs, always check with your specific plan provider or use the official SilverSneakers website. By doing your research, you can find a plan that supports both your medical needs and your fitness goals for healthy aging.
