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Gym Memberships In Medicare Advantage Plans Cater To Healthy Seniors

By Shefali S. Kulkarni

January 11th, 2012, 5:09 PM

Despite federal regulations that prohibit health insurance plans from cherry-picking their beneficiaries, some Medicare Advantage plans may be doing just that, only indirectly.

A new study from the New England Journal of Medicine suggests that when Medicare Advantage plans alter their benefits to include perks like gym memberships, they tend to attract healthier seniors. That may not be surprising, but Dr. Amal Trivedi, one of the co-authors of the study and a research investigator at the Providence VA Medical Center, says policymakers should take note of this trend, especially moving forward with the health care law.

“Ideally, plans should compete on the basis of their ability to improve quality of care and reduce costs,” he says, “rather than their ability to attract the healthy and exclude the sick.” He says that’s the rationale behind regulating health insurance markets. “[Lawmakers] should be aware that changes to the benefits plan have a big effect.”

The study used national figures from the Centers for Medicare and Medicaid Services to see what kind of changes occurred when 11 Medicare Advantage plans incorporated a gym membership as a part of their covered benefits. “Persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking,” according to the study.

But health plans may not be aware of this effect, and their rationale for incorporating gym membership could be unrelated to enrollment and retention of healthy patients. “We can’t look at why plans are doing this,” Trivedi says. The study suggests that perhaps “offering coverage for fitness-memberships may increase total market share, irrespective of the health profile of the plan’s population.”

Medicare Advantage plans, private or public, are not allowed to deny coverage to Medicare beneficiaries or employ strategies to attract healthier (and less costly) patients. The new health care law also extends these regulations to the individual and small-group health care markets. “But despite those regulations, plans can offer benefits that appeal to certain people,” Trivedi says. “It’s not excluding necessarily. It’s changing the benefits to appeal to the healthy.”

3 Responses to “Gym Memberships In Medicare Advantage Plans Cater To Healthy Seniors”

  1. Rick says:

    You’d have to be a moron to think that good health is not a result of watching your diet and getting plenty of exercise. I guess that explains why we have a whole bunch of morons in the health care industry and the health insurance industry. Tons of morons!

  2. The above explanation is one way to look at this issue. The other is, by offering gym membeships, it encourages people to exercise on a regular basis and observe other healthy behaviors, including dietary practices. The net result is a healthier person, less prone to debilitating conditons and less susceptible to disease. Perhaps all health plans should be adopting this practice. I am a big proponent of this kind of preventive measure.

  3. Andrew says:

    The implication that Medicare Advantage plans are offering this benefit to attract healthier members in unfair and untrue. In fact, they offer these types of benefits to improve the attractiveness of their product such that membership increases, and with an expectation that these programs will help lower overall health care costs. With the advent of risk adjusted Medicare Advantage premiums, health plans have no financial incentive to cherry-pick very healthy members. They do, however, have an incentive to enroll members who want to be healthy (in other words, people who take their health care seriously), regardless of their current health status, and fitness programs are one way to attract those types of members. Remember that many of these fitness programs consist of stretching, modest weight-bearing exercise and water activities that help older people from falling, improve their mental health and assist in the management of expensive chronic diseases such as diabetes.