I think we need to highlight the importance of simply being active. Not everyone is athletic enough to run marathons or lift heavy weights. Everybody can get off their ass and do something, however. I used to spend a lot of time at the gym but lately I spend more time at the golf course. It’s amazing how some of the older guys well into their eighties are doing. I think we intimidate people about exercise when there are a lot of things they could be doing as they age. Moving around and engaging with others has tremendous health benefits as well.
It gets a lot of flak but one neat thing about pickleball is seeing so many old people active - I’d never seen so many 60 year olds actually running before playing the game
Could not agree more. As I commented on Slow Boring recently, I’m grateful every day that I learned to love exercise despite having been a runty and unathletic child. I’m also grateful to live in a walkable place (DC, despite the current unpleasantness) with good transit and decent bike infrastructure. I can see the toll the auto-only lifestyle takes on my friends and family in the midwest.
There’s a documentary on Netflix called Blue Zones (or something similar) and “being active” was one of the common traits across the zones.
In Japan, it was as simple as them sitting on the ground a lot, so they’d have to effectively do squats to get up. Gardening was another common activity there.
They also talked about a city in Italy built into a mountain where the population had to walk up and down hills to go see their friends or go to the store.
So it could almost be as simple as “not sitting on a chair/couch or in a car” to qualify as a healthy lifestyle today.
If anyone will pay for gym memberships be my guest:). In the meantime I would probably encourage people to run or walk for free. I think it also takes out the barrier of taking out more time to commute to the workout.
In Denver, once you turn 60, membership at the large network of city recreation centers is free. All the equipment, all the classes, all the swimming pools -- free. It's one of the best things the city spends money on, IMHO.
Walking is free. If more people spent time walking, the physical, and mental health, of our populations would increase greatly. Unfortunately, part of the problem is we've created a world so comfortable, most people would rather walk over to the cabinet and pop a pill instead of going outside for a walk.
Simply paying a gym membership does not necessary mean they will use it. I think the major problem holding Americans back from exercising let alone being active, is that they are victims to their built environment. It’s so EASY to be inactive. DoorDash, driving to get fast food, not having to walk to go to places leads to an inactive lifestyle.
There are few walkable areas like S.F. and NYC that makes being active a lifestyle not a chore like exercising at a gym.
I obtained a "Silver "Sneakers" card when I signed up for Medicare, I guess I have the advantage plan /plus I have anthem as my secondary. I can go to the local YMCA & Planet fitness, for free. I thought everybody was eligible for this when they signed up for Medicare.
Yes! I was going to make the same comment—technically Medicare does cover gym memberships as my parents have had both silver sneakers and another one (I forget the name at the moment). This type of program both gets “seniors” exercising and gets them out of the house socializing—another crucial ingredient to quality of life.
Re: thought bubble / Medicare covering gym memberships. This would most likely increase “advantageous selection” i.e targeting of healthy, active patients who are likely to cost less than a private Medicare plan (aka Medicare advantage/MA) is payed by the government. Selection in MA is estimated to cost >$40B annually in excess spending (how’s that for waste!) and as of 2025 exceeding excess spend due to “upcoding” as explained nicely on Plain English recently). Btw, a similar mechanism is also the reason private plans offer gym reimbursements and why your auto insurance may offer a discount if you take a drivers ed class… it’s less about getting you to DO things and more about getting information ABOUT you!
re: Medicare/Medicaid not covering gym memberships:
Remember the business model for most gyms: sign up as many people as possible in the hope that most of them will only show up a few times and stop coming while still paying. Sleazier operations make it as difficult as possible to cancel a membership.
So not hard to imagine how this could become a massive boondoggle where gyms sign up large numbers of elderly and poor people, collect money from the Federal government and the new members never show up.
A much better plan would be to reward people for actually exercising, tracking it via an app or similar.
That this is something private health insurance should do too goes without saying, but there may be issues: when I first signed up with my insurance company, they had a program where you would tie your step tracker to their app. Every day you logged more than 12K steps you got a dollar, up to $100.
And for the first three years, I got that $100, but then year four it went down to $50 and now it's down to just $10. Meaning they were clearly losing money. Why they didn't just up the number of steps reqiured instead is curious but to your greater point, we should be rewarding people for exercising.
It is astounding how impactful exercise is. I'm really keen to see what the $101 million Xprize Healthspan uncovers in the next five years. There are many dozens of teams with a variety of approaches and combinations of interventions (exercise, biologics, pharmaceuticals, supplements, etc.).
Even though exercise is significantly better than being chronically sedentary, people who regularly exercise still have decent risk of age-related pathologies, simply due to the biology of aging. I'd be supportive of research that aims to help people who already do the basics of a reasonably healthy diet and exercise. The ARPA-H program PROSPR by Andrew Brack may help shed light on this, as aging biomarkers are an important focus.
Prior to 2024, Medicare Advantage plans were getting increasingly competitive and plans were giving richer "supplemental benefits" for things that are meant to address social determinants of health like gym memberships, grocery/OTC cash cards, non-emergency transport, etc. Then there was a giant acceleration in cost trend, the new v28 risk score model is harming plans, and MA profit margins are getting destroyed, so now plans are cutting back heavily on the supplemental benefits. Rich supplemental benefits are perceived as a driver of adverse selection, especially on the cash cards.
To more directly answer your question, plans don't offer extensive gym reimbursement probably because most seniors don't care about it enough for it to influence their plan choice, and it's probably a low utilized benefit. Like another commenter said, if you wanted to improve health through exercise in the Medicare program, it probably needs to be a quality metric, which will much more strongly change plan behavior and therefore senior behavior.
1. I imagine a similar answer would've been given 5-10 years ago about weight loss: you simply need to eat healthier/less. No drug can mimic that. Turns out: we discovered a drug that doesn't mimic that, but causes a behavioral change that makes people eat healthier/less. So, maybe we should find a drug that makes people exercise more (e.g. by making exercise more enjoyable).
2. We really should study the one condition where exercise isn't helpful. Where it's even counterproductive: ME/CFS. People with ME/CFS get worse from exertion, so called post-exertional malaise. Seems to me, solving that disease would greatly increase our understanding of exercise and how to make it (more) beneficial. (Note: I have this disease)
Yes, exercise is a miracle drug, but it's not why we're living longer than ever.
For the sake of the anti-vax advocates who may stumble upon this, the obvious point should should be made that exercise it is not a substitute for medicine, especially those that prevent communicable diseases.
I think we need to highlight the importance of simply being active. Not everyone is athletic enough to run marathons or lift heavy weights. Everybody can get off their ass and do something, however. I used to spend a lot of time at the gym but lately I spend more time at the golf course. It’s amazing how some of the older guys well into their eighties are doing. I think we intimidate people about exercise when there are a lot of things they could be doing as they age. Moving around and engaging with others has tremendous health benefits as well.
It gets a lot of flak but one neat thing about pickleball is seeing so many old people active - I’d never seen so many 60 year olds actually running before playing the game
Pickleball is so fun with it's ease of play that I can't understand being upset about it.
Agreed that not everybody needs to run marathons.
But everyone should be doing weight training ( unless physically incapable of it of course)
Even eighty year, old people can do weight training and get results
Could not agree more. As I commented on Slow Boring recently, I’m grateful every day that I learned to love exercise despite having been a runty and unathletic child. I’m also grateful to live in a walkable place (DC, despite the current unpleasantness) with good transit and decent bike infrastructure. I can see the toll the auto-only lifestyle takes on my friends and family in the midwest.
There’s a documentary on Netflix called Blue Zones (or something similar) and “being active” was one of the common traits across the zones.
In Japan, it was as simple as them sitting on the ground a lot, so they’d have to effectively do squats to get up. Gardening was another common activity there.
They also talked about a city in Italy built into a mountain where the population had to walk up and down hills to go see their friends or go to the store.
So it could almost be as simple as “not sitting on a chair/couch or in a car” to qualify as a healthy lifestyle today.
If anyone will pay for gym memberships be my guest:). In the meantime I would probably encourage people to run or walk for free. I think it also takes out the barrier of taking out more time to commute to the workout.
Same with dumbbells. Buy a few and lift them at home 3 times a week. No driving, no fee.
Also the barrier of a lot of expensive equipment!
In Denver, once you turn 60, membership at the large network of city recreation centers is free. All the equipment, all the classes, all the swimming pools -- free. It's one of the best things the city spends money on, IMHO.
Walking is free. If more people spent time walking, the physical, and mental health, of our populations would increase greatly. Unfortunately, part of the problem is we've created a world so comfortable, most people would rather walk over to the cabinet and pop a pill instead of going outside for a walk.
Simply paying a gym membership does not necessary mean they will use it. I think the major problem holding Americans back from exercising let alone being active, is that they are victims to their built environment. It’s so EASY to be inactive. DoorDash, driving to get fast food, not having to walk to go to places leads to an inactive lifestyle.
There are few walkable areas like S.F. and NYC that makes being active a lifestyle not a chore like exercising at a gym.
I obtained a "Silver "Sneakers" card when I signed up for Medicare, I guess I have the advantage plan /plus I have anthem as my secondary. I can go to the local YMCA & Planet fitness, for free. I thought everybody was eligible for this when they signed up for Medicare.
Yes! I was going to make the same comment—technically Medicare does cover gym memberships as my parents have had both silver sneakers and another one (I forget the name at the moment). This type of program both gets “seniors” exercising and gets them out of the house socializing—another crucial ingredient to quality of life.
Re: thought bubble / Medicare covering gym memberships. This would most likely increase “advantageous selection” i.e targeting of healthy, active patients who are likely to cost less than a private Medicare plan (aka Medicare advantage/MA) is payed by the government. Selection in MA is estimated to cost >$40B annually in excess spending (how’s that for waste!) and as of 2025 exceeding excess spend due to “upcoding” as explained nicely on Plain English recently). Btw, a similar mechanism is also the reason private plans offer gym reimbursements and why your auto insurance may offer a discount if you take a drivers ed class… it’s less about getting you to DO things and more about getting information ABOUT you!
It would also fund a lot of well-intended but unused gym memberships.
re: Medicare/Medicaid not covering gym memberships:
Remember the business model for most gyms: sign up as many people as possible in the hope that most of them will only show up a few times and stop coming while still paying. Sleazier operations make it as difficult as possible to cancel a membership.
So not hard to imagine how this could become a massive boondoggle where gyms sign up large numbers of elderly and poor people, collect money from the Federal government and the new members never show up.
A much better plan would be to reward people for actually exercising, tracking it via an app or similar.
That this is something private health insurance should do too goes without saying, but there may be issues: when I first signed up with my insurance company, they had a program where you would tie your step tracker to their app. Every day you logged more than 12K steps you got a dollar, up to $100.
And for the first three years, I got that $100, but then year four it went down to $50 and now it's down to just $10. Meaning they were clearly losing money. Why they didn't just up the number of steps reqiured instead is curious but to your greater point, we should be rewarding people for exercising.
Very much agreed.
I would go further and argue that if you are on medicaid, you should be doing your part to reduce those expenses.
Which means staying a healthy weight and being fit
I have an Apple Watch.. the two things I monitor daily are my 3300 step goal and my sleep.. It’s a life changer..I’m 74….
It is astounding how impactful exercise is. I'm really keen to see what the $101 million Xprize Healthspan uncovers in the next five years. There are many dozens of teams with a variety of approaches and combinations of interventions (exercise, biologics, pharmaceuticals, supplements, etc.).
Even though exercise is significantly better than being chronically sedentary, people who regularly exercise still have decent risk of age-related pathologies, simply due to the biology of aging. I'd be supportive of research that aims to help people who already do the basics of a reasonably healthy diet and exercise. The ARPA-H program PROSPR by Andrew Brack may help shed light on this, as aging biomarkers are an important focus.
"Is there a good reason why Medicare and Medicaid don’t typically cover gym memberships?"
Medicare Supplement ("Medigap") plans often cover gym memberships.
Shuttering USAID is shameful. People forget all the famine from the 80s that let to its creation.
Prior to 2024, Medicare Advantage plans were getting increasingly competitive and plans were giving richer "supplemental benefits" for things that are meant to address social determinants of health like gym memberships, grocery/OTC cash cards, non-emergency transport, etc. Then there was a giant acceleration in cost trend, the new v28 risk score model is harming plans, and MA profit margins are getting destroyed, so now plans are cutting back heavily on the supplemental benefits. Rich supplemental benefits are perceived as a driver of adverse selection, especially on the cash cards.
To more directly answer your question, plans don't offer extensive gym reimbursement probably because most seniors don't care about it enough for it to influence their plan choice, and it's probably a low utilized benefit. Like another commenter said, if you wanted to improve health through exercise in the Medicare program, it probably needs to be a quality metric, which will much more strongly change plan behavior and therefore senior behavior.
Move it or lose it. Especially as you age.
Two thoughts on exercise:
1. I imagine a similar answer would've been given 5-10 years ago about weight loss: you simply need to eat healthier/less. No drug can mimic that. Turns out: we discovered a drug that doesn't mimic that, but causes a behavioral change that makes people eat healthier/less. So, maybe we should find a drug that makes people exercise more (e.g. by making exercise more enjoyable).
2. We really should study the one condition where exercise isn't helpful. Where it's even counterproductive: ME/CFS. People with ME/CFS get worse from exertion, so called post-exertional malaise. Seems to me, solving that disease would greatly increase our understanding of exercise and how to make it (more) beneficial. (Note: I have this disease)
Yes, exercise is a miracle drug, but it's not why we're living longer than ever.
For the sake of the anti-vax advocates who may stumble upon this, the obvious point should should be made that exercise it is not a substitute for medicine, especially those that prevent communicable diseases.