Medicare is the federal health insurance program that provides health insurance coverage for people 65 or older, those under 65 with specific disabilities, or any age with end-stage renal disease. It is funded by payroll taxes, premiums paid by beneficiaries, and general government revenues. It is divided into four parts:
- Part A is hospital insurance. It covers a patient’s hospital stays for those formally admitted, nursing hospital care for only those formally admitted for three consecutive days, hospice care, and some home health care services.
- Part B is medical insurance which covers doctor visits, outpatient care, preventive services such as the administration of vaccines and medical equipment and supplies. Tests covered are like cancer screening or diabetes.
- Part C (Medicare Advantage) is a private insurance option for covering hospital and medical costs. It may also cover prescription drugs and have extra benefits such as vision, hearing, and dental. You must first enroll in parts A and B to sign up for part C.
- Part D covers prescription medications that are self-administered and not administered by a doctor, like injections. The plan is optional.
Medicare Supplement Insurance (Medigap) is additional private health insurance that you can purchase to help pay for costs not covered by other plans. These costs include copayments, coinsurance, and deductibles. You must pay a monthly premium to get the insurance but also need inpatient and medical coverage (Plan A and B) to purchase Medicare Supplement Insurance.
Exercise physiology is the science that focuses on studying how exercise affects the body and how different types of exercise impact the human body. Exercise physiologists use their knowledge of human anatomy and physiology to help people with chronic conditions manage and improve their health, such as diabetes or heart disease. This article will discuss what parts of Medicare cover exercise physiology and to what extent.
Medicare Part A does not cover exercise physiology services. If you only have this cover, you must incur the costs or use other funding sources such as private health insurance or community programs.
Under Medicare part B, you may qualify for initial medical nutrition therapy services in the first year of treatment. You may also be eligible for follow-up services each subsequent year. These services may include personalized exercise plans based on a beneficiary’s health needs.
Medicare Part C, or Medicare Advantage, may provide coverage for exercise physiology as an additional benefit. The insurance broker Clearmatch Medicare can help you with choosing a right Medicare Advantage plan with the benefits you need. Other benefits vary by plan. Some Medicare Advantage plans include benefits related to exercise or physical activity, such as coverage for gym memberships, fitness classes, health coaching, or personal training. These benefits can vary depending on the specific plan and the location in which you live. You will have to discuss with the insurance company directly to determine whether exercise physiology benefits are included and, if so, what is covered. You will have to pay a monthly premium, a deductible, a copayment, or coinsurance for the services to get this coverage.
In summary, Medicare is an important program providing millions of Americans with health care coverage. Reducing patient costs helps them save money for other expenses, as Medicare insurance covers most of their bills. However, it does not cover all healthcare expenses, and coverage may vary depending on the specific plan and provider. Beneficiaries may still need to pay for some services from their pockets or through other funding. Medicare coverage for exercise physiology depends on whether you have Original Medicare or Medicare Advantage. It also depends on whether you have a chronic condition and complex care needs that qualify you for a rebate and what benefits your plan offers. It is always a good idea to check with Medicare or your healthcare provider to determine if a particular service is covered.
Medicare may cover medically necessary physical therapy, including exercise physiology services, when prescribed by a doctor or other qualified healthcare provider. Medicare may not cover services deemed primarily for general fitness or weight loss rather than for treating a specific medical condition. If you are unsure if Medicare covers a particular exercise physiology service, consult your healthcare provider and check with Medicare.
