I have had two clients ask me about fitness club memberships with Medicare Advantage in the last week. The first client wanted to change her husband’s Medicare Advantage plan during Medicare’s Annual Election Period this year. The “AEP” is October 15 – December 7.
She told me that the fitness club membership was the deciding factor behind her husband’s decision to use Medicare Advantage rather than Medigap. Unfortunately, she is not satisfied with the health care providers that are in her husband’s current Medicare Advantage plan. She wanted me to verify that if she changed his plan for 2013, he would still be able to use the facilities at the same fitness club.
I did some research for her. The good news is that the plan in which she is interested offers fitness club memberships as part of the coverage. The bad news is that not every Medicare Advantage plan does.
Medicare Advantage plans are only required to offer the same benefits as original Medicare. They are allowed to offer more, if they want. Many Medicare Advantage plans offer prescription drugs, dental and vision insurance and fitness club memberships. However, not all of them do.
Her timing might have been a week or so early. Medicare Advantage plans will be sending out their renewal information very soon. My recommendation was for her to review the renewal information she would be getting. Medicare Advantage plans are free to alter their benefits and networks each year. If her husband’s current Medicare Advantage plan has adjusted its network of health care providers to include the doctors and hospitals she wants, she does not need to do anything.
If the plan has not made the network adjustments she wanted, I assured her that we could change her to a more suitable plan for 2013 during the AEP.
A couple of days after that, another client called me to ask if the fitness club membership was also a part of Medigap. She had been visiting with a friend who mentioned that her gym membership was paid by her health insurance.
I explained to her that there is a huge difference between Medicare Advantage and Medigap. Both plans are administered by private insurance companies but that is where the similarities stop.
Medicare Advantage is not a supplement to Medicare. It is an alternative. Medicare Advantage is built on the “Managed Care” or “HMO” model. Among other things, that means that Medicare Advantage plans have a geographic limitation. Yes, they offer benefits, like gym memberships, that regular Medicare does not but they are only available in a specific area.
Medigap is also called Medicare Supplement. If Medicare pays towards a claim, Medigap will as well. There is no geographic limitation. If a health care provider accepts Medicare, he will also accept Medigap.
In my opinion, Medicare Advantage is a fine program for people who are content with the network of health care providers that are in the network, have no problems with the “nickel and dime” fees and prefer to have all the extra benefits that Medicare does not offer.
Those folk who do not like the “nickel and dime” deductibles and co-pays that are in most Medicare Advantage plans, visit family in a different area or just like to travel now that they are retired, will probably like Medigap better. They will just have to pay for a gym membership on their own if that is what they want.