Should Medicare money be spent on free gym memberships for seniors? Medicare pays Medicare Advantage plans a lot of money to cover seniors’ medical expenses and manage their health care. Critics of these plans say they shouldn’t be spending money on free gym memberships for people who enroll in Medicare Advantage.

In Tucson, around 18,000 people are enrolled in Medicare Advantage plans (and one Medigap plan) that offer free gym memberships. About 5,300 (35%) use their gym membership on a regular basis.  Silver Sneakers contracts with Advantage plans to manage the fitness program for seniors at more than 20 facilities in Tucson.

At the Pro Fitness gym on Prince Road, 200 to 300 seniors use the facility 2 to 3 times per week. They can use weight machines, tread mills, and the pool.  Or, they can participate in Silver Sneakers classes that offer light exercise and aerobics specifically designed for seniors. Classes are held three times per week, both morning and evening.

The Silver Sneakers class I visited had 15 participants who spent an hour moving, stretching, lifting light weights, and working up a sweat. The oldest participant was a 94-year old woman, and the youngest was a man in his 30′s who is on Medicare because of a disability.

Megan Ewald, an account manager for Silver Sneakers, has some good stories to tell about the benefits of working out. She is aware of three marriages that resulted from meetings at Silver Sneakers classes around town.

Critics of Medicare Advantage say plans attract healthier seniors with free gym memberships. But the people I observed at the Silver Sneakers class were a mix of ages and fitness levels. There was the 94 year old woman, and the young man who had suffered a stroke. There was a man with a walker, and at least two women who were working on losing weight. One of them said she had lost 25 pounds through exercise and diet, all because of her free gym membership.

With so many Americans overweight and sedentary, why not reward people for going to the gym? It seems like money well spent.

This is my week to tell people they don’t need my services.  I talked to three people who have the state Medicare retiree plan because they are retired teachers. They thought they were paying too much for their Medicare Advantage plan (about $100 per month), and they had issues with referrals that come with an HMO.  I went through their evidence of coverage book and concluded that their plan is awesome, and I told them so.

The plan I was looking at is a Medicare Advantage plan, but it’s not like the ones I enroll people in.  Here are just a few of the awesome benefits:  Hospital co-pay: $100 (that’s it!); Part B drugs (like chemotherapy): 0% co-pay; Radiation therapy: 0% co-pay. Part D coverage: no donut hole!!

As an insurance agent I’m not supposed to mention benefits, but I am describing a plan I do not sell. And it is a plan that other insurance agents should not move people out of to put them into a $0 premium Medicare Advantage plan they sell.

Some people don’t need Medicare.

Yesterday I got a call from a man who turns 65 in November. He told me his wife is still working and her employer is a big company, which is a very important factor. This man has his Medicare card and will start paying his Part B premium next month.  I told him to find out how much his wife is paying to have him on her insurance and to find out if the insurance is good coverage. But because her employer is a national, large company, the health insurance is probably pretty good – and he may not need his Medicare.

If a person is covered by employer health insurance after they turn 65, they don’t need to enroll in Medicare Part B and pay the premium. The company must have more than 20 employees. However, people who work for small-to-medium size companies (with over 20 employees) often have lousy and expensive health insurance, so they might be better off using their Medicare.

I told this potential customer to investigate his health insurance, how good it is, and how much it costs. I also told him he could use Medicare as secondary insurance to (possibly) cover deductibles and co-pays. But I had to admit I have not dealt with this, so I referred him to the Medicare.gov website.  I told him he could also call 1-800-MEDICARE to learn more about how Medicare co-ordinates with other health insurance.

Medicare Advantage plans in Arizona are not changing a lot for 2012. But everyone enrolled in these plans must check to be sure their Advantage plan will work for them next year, because the time to change plans is coming up. The Open Enrollment Period runs from October 15 – December 7.

If a person has issues with their Medicare Advantage plan, now is the time to act, or remain in that Advantage plan for 2012. Some people have discovered that their Medicare Advantage plan is not working for them for various reasons.

*Will your doctor(s) still accept the plan in 2012? I have heard that some doctor groups and some primary care physicians will no longer work with certain Medicare Advantage plans in 2012. (Sorry, I can’t name names because I am an insurance agent.) You should call your doctors and ask if they will be taking your plan next year.

*Have you discovered that your plan’s doctor network is too restricted/small? Some people have discovered that their plan has a limited number of specialists and other providers in its network. If that matters to you, now is the time to look into other options.

*Have prior authorizations or referrals made it difficult or impossible to get tests your doctors want you to have? Some plans make it very difficult to get approval for tests like MRIs. If this has been an issue, now is the time to look at other options.

*Are all of your brand drugs still covered by your plan?  I was looking at the Annual Notice of Change for one Medicare Advantage plan and the instructions said something like, “We have decided to no longer cover certain prescriptions. We suggest you look up your prescriptions on our on-line formulary to be sure all your drugs will be covered by the plan in 2012“.  That’s not a direct quote, but that was the message. It seems it is up to each person enrolled in a Medicare Advantage plan or Part D plan to check to be sure their brand drugs will still be covered in 2012.  Yikes.