Fitness & Insurance Guide: From Weight Loss Drugs To Gym Memberships
Following the global pandemic of 2020 , insurance companies have increasingly supported policy coverage for fitness and wellness endeavors, including gym memberships, weight loss drugs, and mental health services, among other offerings.
Overall, 85% of 100 insurance providers surveyed by Reinsurance Group of America said they’re making wellness policies a “priority”. Additionally, over 60% of insurers said they’ve already put wellness program coverage into their insurance policies.
That emerging scenario tracks well with what consumers are thinking on the health and wellness front.
A December, 2023 study by Forbes Health shows that getting and staying healthy is the “most common” resolution at the end of last year.
That’s good news, but what does it mean for consumers, companies, and the insurance industry in 2024? On the upside, more wellness-based insurance products are becoming available. On the downside, there are still some health and wellness treatments that insurance companies aren’t covering.
Here’s an inside look at where the issue of health and wellness insurance policies stand in 2024 – and how that shakes out for health and wellness consumers who are looking for good coverage.
Insurance Coverage for Weight-Loss Drugs
In the past 18 months, weight loss prescription drugs have become big business in the dieting industry, with the investment firm Barclays estimating the industry will grow to $100 billion in value by 2030.
Weight loss drugs like the class GLP-1diabetes drugs Ozempic and Wegovy are particularly popular with the public, and U.S. employers are grasping that reality. Over 43% of U.S. companies say they will cover the cost of GLP-1 drugs in 2024, up from 25% in 2023, according to healthcare provider Accolade.
Meanwhile, insurance companies seem to be dragging their feet on including popular weight loss drugs in their insurance coverage.
“When a weight loss drug Ozempic is prescribed as a drug for treating type-2 diabetes, it is covered under insurance,” says Dan Gallagher, a registered dietician at Aegle Nutrition. “However, most insurance companies are not covering the drug for weight loss purposes.”
Insurers may provide coverage in some extreme cases of morbid obesity, but it’s rare.
“Considering that people are paying out of pocket, somewhere around $900-1300 per month and the fact you need to stay on the drug to continue to see the effects of it, prescription weight loss drugs can get costly for consumers,” Gallagher says.
Insurers may finally be coming around on insuring weight loss drugs.
“Insurance companies have largely been sort of neutral on drugs like Ozempic,” says Timothy Cannon, founder at Paramount Life Insurance Advisors. “Life insurance companies currently do offer coverage to applicants on Ozempic with no issues especially if they are not diabetic.”
As is often the case in the insurance sector, there are caveats.
“If the weight loss drug is linked to diabetic issues they may be declined depending
on the product and company,” Cannon notes. “This is due to diabetes not the Ozempic drug
itself. Insurers are being largely neutral regarding weight loss drugs as long as it is not linked to any current medical conditions like heart issues.”
Cosmetic Surgery Coverage
Give the “elective” nature of most cosmetic surgery procedures, insurers aren’t lining up to cover those “nip-and-tucks” and liposuctions.
“Health insurance policies are primarily focused on covering medical treatments and procedures that address underlying medical conditions or enhance health,” states ICICI Lombard Insurance in a recent research note . “Cosmetic surgery, performed solely for aesthetic purposes, is typically not covered by health insurance.”
In certain instances, reconstructive surgery can be covered under general health insurance policies if the procedure “restores function or correct deformities resulting from accidents, congenital conditions, or medical treatments,” the company states.
Consumers interested in pursuing coverage for cosmetic surgery should check the terms and conditions of their health insurance plans to see what procedures might be covered and in what instance.
More realistically, restorative surgery providers usually offering financing options so patients can make payments over time, as insurance for such surgeries are few and far between.
Medicare Medicaid Fitness Coverage
The two public health insurance platforms – Medicare and Medicaid – don’t usually cover fitness services like gym memberships, prescription drug medications, and wellness products and services.
Yet like the rest of the insurance sector, both programs are gaining ground on health and wellness insurance coverage.
“Medicare and Medicaid are gradually recognizing the value of preventive health measures,” says George Yang, founder of Yanre Fitness and a certified health education specialist (CHES). “Some fitness-related services, like physical therapy, are covered, especially when deemed medically necessary.”
However, coverage for gym memberships and health clubs remains limited. “We’ve
seen an increase in clients using health savings accounts for gym memberships, indicating a shift towards recognizing fitness as preventive care,” Yang says.
Both government sponsored health care insurers also make a distinction between what is necessary and what is elective when it comes to wellness-based health insurance coverage
“They’ll cover physical therapy or preventative doctor visits but rarely gyms or diet pills, which Medicare and Medicaid consider lifestyle expenses,” says Tom Smith, a spokesperson for Nirvana Super, an infused beverage company that specializes in health-based drinks.
Scott Maibor, a Medicare expert and agent at Senior Benefits Boston, says Medicare/Medicaid typically don’t provide fitness or gym related benefits – but there are caveats and opportunities for consumers.
“The best fitness/gym benefits are with the Medicare Advantage plans,” Maibor says. “These range from free Fitbits and online classes to free gym memberships in networks such as Silver Sneakers and Renew Active,” he says. “One carrier is even offering a $300 quarterly reimbursement for virtually ANY type of fitness expense that could be a bowling ball, greens fees, fishing rods, sneakers, or hiking poles, and more.”
“Physical therapy and weight loss programs are generally covered by Medicare when deemed medically necessary,” Maibor notes.
“Weight loss programs are typically going to be limited to screenings, dietary assessment and nutrition counseling and have a BMI requirement to qualify” he adds. “Unlike Medicare Advantage plans, traditional Medicare will not pay for popular weight loss programs.”
Gym and Fitness Program Coverage
Employer-sponsored coverage trends for fitness-related benefits, including gym memberships and wellness programs, can vary widely.
Insurance coverage for at-home workout equipment or fitness-related injuries typically falls under health insurance, but specifics depend on individual policies,” says Chris Looney, CEO at SporesMD an alternative health and wellness company.
Even so, employer-sponsored fitness coverage trends are showing increased inclusion of fitness-related benefits in employer-sponsored plans.
“Increasingly coverage may extend to gym memberships, fitness studio classes, physical therapy, and even personal trainers and massage therapists, aligning with the emphasis on employee well-being,” says Eliezer Zupnick, an insurance advisor and the founder of East Insurance Group, a commercial insurance firm.
Andrew White, a Rock Round, Tex.-based certified personal trainer, says he’s noticed a growing trend among employers offering fitness-related benefits that covers employees’ fitness needs.
“These can include subsidized gym memberships, wellness programs, or access to services like physical therapy and personal training,” White says. “These benefits are increasingly viewed as a way to foster overall employee health and well-being, potentially reducing healthcare
costs and boosting productivity, which is good news for employees and employers.”
Industry experts also sees a rise in quality insurance for at-home workout equipment.
“Standard health insurance policies generally don’t cover at-home workout equipment, such as weights or Peloton bikes,” White says. “However, we’re seeing some health insurance plans
or employer-provided wellness programs may offer reimbursements or stipends for at-home fitness equipment as part of a broader wellness initiative.”
At home fitness consumers should document their equipment and service purchases and submit them to either their insurance company under a general home and life policy or to their employer, if they qualify for coverage.
Additionally, if a health and fitness consumer is looking for insurance coverage for fitness-related Injuries, start with your insurer.
“With fitness-related injuries, coverage usually depends on an individual’s health insurance policy,” White notes. “Injuries sustained during workouts at a gym, at home, or outdoors are typically covered under most standard health insurance plans, but the extent of the coverage can vary based on the policy’s terms and conditions.
Fitness Insurance Trends for 2024
Looking ahead to the rest of 2024, health and wellness experts anticipate a continued increase in wellness and fitness-related benefits in health insurance policies.
“This is likely driven by a growing acknowledgment of the importance of preventive
health measures,” White says. “There may also be more focus on holistic health approaches that integrate physical fitness with mental health and nutrition, reflecting a more comprehensive perspective on health and wellness.”
Zupnick also sees growth in the gym, fitness and wellness insurance realm as the year progresses, especially in three key areas.
Personalized health and wellness plans: Insurers may increasingly tailor coverage to individual fitness needs.
Telehealth integration: Expansion of telehealth services for fitness consultations and rehabilitation.
Innovative wellness incentives: Insurers may offer incentives for policyholders who meet specific health and fitness goals.
To get the best results on personal fitness and wellness insurance coverage, do your due diligence and ask your insurance provider’s questions on coverage.
“People should fully understand their insurance policies, especially how they relate to fitness and their unique wellness activities,” White says. “Being well-informed about these trends can empower individuals to make more informed decisions about their health and fitness journeys.”