Exercise programs have a lot of benefits to them. Not only can you shed some extra pounds, but exercise provides countless other benefits – both physical and mental. However, despite their health benefits, exercise isn’t technically a healthcare treatment.
Which leads to a common question a lot of people wonder about… “does Medicare cover exercise programs?” In this article, we answer that question in clear, plain English.
Does Medicare Cover Exercise Programs?
The short answer is no. In most cases, Medicare will not cover the cost of exercise programs. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your exercise programs.
Original Medicare (Medicare Part A and Part B) typically does not provide coverage for exercise programs. This means you will have to pay 100 percent for any exercise program you want to take. Original Medicare does not provide coverage for exercise programs because it mainly covers what it considers to be medically necessary services, equipment, and treatments.
Original Medicare does not provide coverage for gym and fitness memberships either. This is because these memberships are considered lifestyle choices rather than medically necessary treatment for an illness.
However, there are some situations when you can get Original Medicare to provide coverage for your exercise programs.
Supervised Exercise Therapy
Original Medicare may provide coverage for up to 36 sessions of Supervised Exercise Therapy, or SET, for 12 weeks if you have peripheral artery disease or PAD. However, for Original Medicare to provide coverage for your SET, it must meet these requirements:
- Each session must last only 30-60 minutes long for patients with PAD
- It must take place in a doctor’s office or hospital outpatient setting
- Each session is supervised by a doctor, nurse practitioner, or physician assistant who knows life support training
- The SET is conducted by support staff who are trained in running exercise programs for PAD patients
- It is ordered by your healthcare provider in a face-to-face visit
It is possible to be eligible for 36 more sessions of SET as long as you get your healthcare provider’s approval.
Original Medicare may also provide coverage for exercise programs for cardiac rehabilitation. Coverage for exercise programs is provided by Medicare Part B since it usually takes place in an outpatient hospital setting or a doctor’s office.
However, for Medicare Part B to provide coverage, it must be first ordered by your healthcare provider and you must have at least one of these heart conditions:
- A heart attack in the last year
- Heart valve replacement or repair
- Heart transplant or heart-lung transplant
- Coronary artery bypass procedure
- Current stable angina pectoris or commonly known as chest pain
- Chronic heart failure
- Coronary angioplasty
- Coronary stent
Part C Coverage for Exercise Programs
There are many Medicare Advantage plans (Medicare Part C) that provide coverage for exercise programs. Medicare Advantage plans must cover everything that Original Medicare does.
But these plans usually also cover additional benefits with exercise programs being a fairly common one. The specifics of what each program covers and what the costs are will vary from plan to plan.
Some Medicare Part C plans provide coverage for gym and fitness memberships. Your Medicare Part C plan may offer gym membership plans or membership discounts for your overall health and wellness.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover laser back surgery?