UNITED STATES—Toni, two of my neighbors told my wife that they get free gym membership through Medicare. Any truth to that, as I never heard about this before? Regards, Sammy from San Diego.
Hi there…Sammy: Sammy the answer is NO! Medicare Parts A and B do not provide a gym membership for those who are enrolled in Medicare. It would be logical if they did because exercise does keep you healthy.
In the Medicare & You handbook under “What’s NOT Covered by Part A & Part B?” It states… “Original Medicare does not cover everything and if you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless you have other insurance to cover the costs unless…
■ You have other coverage (including Medicaid) to cover the costs.
■ You’re in a Medicare Advantage Plan that covers these services.
Some of the items and services that Original Medicare doesn’t cover include:
✘ Most dental care.
✘ Eye examinations related to prescribing glasses and eye wear.
✘ Cosmetic surgery.
✘ Hearing aids and exams for fitting them.
✘ Long-term care. See more information about paying for long-term care in the Medicare & You handbook.
✘ Concierge care (also called concierge medicine, retainer-based medicine, boutique medical, platinum practice, or direct care).
✘ Covered items or services you get from an opt-out-doctor or other provider (except in the case of an emergency or urgent need)
An extra benefit that helps to enhance Medicare Advantage Part C plans is that when one enrolls, they are offered Silver Sneakers or other types of memberships which provides a gym benefit. The Toni Says ® Medicare team always advises those new to Medicare or changing their Medicare plan to discuss if their primary care doctor or specialists are in that Medicare Advantage plans network.
Since Original Medicare does not cover dental, I would recommend that you talk to your dentist and see which dental insurance plan he/she prefers.
There are 2 different types of dental plans:
1) Traditional or indemnity dental insurance plans which is generally higher in premium and the preventive services are usually covered at 100 percent, basic restorative is generally covered up to 80 percent and major procedures at 50 percent. Many of the traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc.
2) Discount dental plans are generally less expensive than traditional dental plans. These plans provide a discount for services, but your dentist must be part of the plan and agree to give the dental discount.
Medicare and You handbook discuss eyeglasses (after cataract surgery) which is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. The Medicare Part B deductible will apply for the cataract surgery and you will pay the 20 percent of the Medicare-approved amount.
Medicare defines glasses as an elective. I am not sure why glasses are considered elective (not covered), since we do need to see to drive, but it is.
Hearing aids are also considered elective. “Medicare covers the exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay the 20% of the Medicare-approved amount and the Part B deductible applies.”
For assistance with enrolling and personalizing your Medicare, contact the Toni Says® office at 832-519-8664.
Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021 Medicare Survival Guide® Advanced book at www.tonisays.com. Have a Medicare question, email firstname.lastname@example.org?
Written By Toni King