Preventive Medicine

January 22, 2008 11:22 AM

Why don't insurance companies cover or help cover gym memberships?

I have had multiple jobs, and exactly 1 offered $300 if you went to the gym for a certain number of times every quarter.
Is it the insurance company that offers the benefit or the employer that needs to insist on it? (and probably pay a premium for the privilege)

Are there any reasons insurance companies shouldn't do this, or have the bean counters (accountants) already crunched the numbers, and figured out that the cost involved in running the program, tracking the participants, and issuing the reimbursements does not result in lower health care costs?
But then aren't the few companies who offer it (Cigna?Oxford?) not meeting their fiduciary obligations to their shareholders? Or are their bean counters using a different accounting formula to show a savings to the company in reduced health care costs?

posted by MrMulan to health & fitness (24 answers total)

Why don't dental insurance plans cover implants instead of bridges? It just doesn't make financial sense for insurance companies to provide preventative care that won't benefit them when you're not their customer 40 years down the road. If it could be shown that health club attendance dropped mortality rates by 90% per visit per week, I'm sure they could be coerced, but you underestimate the sludge with which insurance tracks progress. I still can't find a dentist that continues to use metal fillings, even though my dental insurance company seems to think they're the only ones worth paying for.
posted by kcm at 11:29 AM on January 22, 2008

I think that some health insurance companies do give a discount if you belong to a health club. However, I haven't heard of any of them outright paying for the membership.
posted by Afroblanco at 11:34 AM on January 22, 2008

The idea is that relatively few people are deterred from exercise because of the cost. Go to the gym 2 January, and you will see lots of people out 3-6 month membership fees who will quit before 1 February. Exercise is so overwhelmingly good for you from a rational standpoint that further rational inducement (a small discount on insurance) is probably not going to matter.

In the US there is also very little reason for any health insurance carrier to support long-term preventative care. Most people change insurers every few years, either because their job changes or because their employer gets a better deal from another company. Much of the cost comes after people qualify for Medicare. An insurer incentivizing exercise would realize only a small portion of the benefit and all of the cost.

Since it's experimental, it would be impossible to say that it would be violating the fiduciary responsibility. It could also be defended as a marketing tool as much as a genuine cost-saver.
posted by a robot made out of meat at 11:35 AM on January 22, 2008

It just doesn't make financial sense for insurance companies to provide preventative care that won't benefit them when you're not their customer 40 years down the road.

... is the reason.
posted by mmdei at 11:37 AM on January 22, 2008

Some do. I think Empire BC/BS in New York offers a rebate based on gym membership (and visitation).
posted by crickets at 11:39 AM on January 22, 2008

My insurance company gives you 'points' which you can spend on cheap 'rewards'. Points are given for every day which you exercise (30 mins or more, low threshhold for 'exercise'). I figure this is about how much they figure it's worth, so a $5-$20 item a month and a half. Which is less than a gym membership.
posted by Comrade_robot at 11:39 AM on January 22, 2008

BCBS Mass does $150 rebates at the end of the year if you've been a gym member for at least four months.
posted by olinerd at 11:41 AM on January 22, 2008

My employer gives $20/month toward your gym membership if you work out the required number of times per month.
posted by fiercecupcake at 11:51 AM on January 22, 2008

Piggyback: I've never understood why they won't cover smoking cessation, either.
posted by dirtynumbangelboy at 11:54 AM on January 22, 2008

And (hit send too soon) it makes more sense now.
posted by dirtynumbangelboy at 11:54 AM on January 22, 2008

In addition to the long term benefits vs short term costs issue that kcm stated and mmdei repeated there's three more reasons.

One lesser reason is likely that the percentage of people who pay gym fees and then never go is very high. Possibly even the majority of gym members - Grod knows I've been one of those in my life. So why would the insurance company pay for something that has very good odds of never being used?

Another small reason is that there's also some risk to an insurance company when you exercise. You'll see the doctor for tennis elbow or if you strain or break something. In the big picture it's a winner but it's not a zero-risk investment.

The bigger reason is "why bother?" Like every other business, insurance companies make in profit the amount they bring in minus the amount they pay out, assuming that's a positive number. In an insurance company's case that's the difference between what they pay out in claims and what they charge in premiums. If the odds are that they'll pay out more in claims, based on the demographics of the pool of people, they'll just charge higher premiums.

If they have no control over the pool of people they insure then that's one thing, but often they can classify people and upcharge the higher risks. Selling a $100 item for $110 is no more profitable than selling a $1 item for $11.

Your employer (when they provide insurance) has a larger incentive to improve your health and that's why you'll see this kind of thing as an employer incentive not an insurance one.
posted by phearlez at 12:05 PM on January 22, 2008

Health Partners in Minnesota covers both gym membership (partial $150-$300/yr) and smoking cessation. They also cover nutritional classes and other weight loss plans. I think Blue Cross does too. I'm not sure about United Heath and smoking cessation but they do have a weight loss program.

I think insurance companies are starting to come around on this. They all end up paying in the end. Both smokers and the obese are likely to run into major health complications (diabetes / heart attack / cancer / sever asthma) before they even qualify for Medicare.

Maybe it helps that Minnesota requires health insurance companies to run as non-profit in this state.
posted by thewalrusispaul at 12:53 PM on January 22, 2008

My health insurance provides a 50% reimbursement of health club fees for nearly all the health clubs around me. So did my last insurance provider, now that I think about it.
posted by Dee Xtrovert at 1:35 PM on January 22, 2008

IIRC my health insurance helps pay for smoking cessation, but not gym membership. (mr. epersonae asks this question out loud at home periodically, usually when we are thinking about joining the Y to be able to use the pool. I'm lucky enough to have a workout room at my current job, but he isn't.)

I wonder if it's something that you could use a health savings account for?
posted by epersonae at 2:31 PM on January 22, 2008

My insurance company in Australia paid for Weight Watchers. HOWEVER, they'd only pay it once you'd already done the program and brought in your little book with all the notarized stamps on it. You couldn't pre-pay for a bunch of meetings and then expect to claim it immediately.

So I'm guessing that with gym memberships, they probably imagine that most people won't actually go.
posted by web-goddess at 4:50 PM on January 22, 2008

I am on the Blue Cross Blue Shield panel and they have questioned us numerous times about gym memberships and reimbursement. I think the number one issue is that they want to monitor how much people use their gym memberships while people just want a free service with no monitoring.

Overall, I get the impression that they want to have your employer provide the service and incentive to go to the gym and I don't know how far they are in convincing employers that this is worth their while.

Otherwise, BCBS does have a small financial incentive for my employer group in Illinois. We can have reduced annual fee to subscribe to Curves gym. However, they did not reduce the monthly fee which is the big stickler for me.
posted by aetg at 5:13 PM on January 22, 2008

OK, sure, in the long run exercise promotes health. But in the short run - what your HMO is worried about - maybe you're more likely to need health care because of stupid rookie workout injuries. Does anyone agree or disagree?
posted by Sfving at 5:31 PM on January 22, 2008

Some do. The same folks at the US Dept of Labor than may be able to answer CrayDrygu's portability question > can help you sort out why your employer may or may not--there are rules to employee wellness programs, as this kind of "reward" is known as in the biz.

Is it the insurance company that offers the benefit or the employer that needs to insist on it?

Depends on whether the plan is fully insured (insurance company's decision) or self-insured (more nuanced, but basically the employer's call).
posted by Pax at 5:42 PM on January 22, 2008

Sorry mean to link this.
posted by Pax at 5:47 PM on January 22, 2008

My employer has a $150 Physical Activity Rebate you can earn. They don't care if you go to a gym or do it on your own. You just need to log the time every month.
posted by smackfu at 6:51 PM on January 22, 2008

Harvard Pilgrim covers up to $150 for every 4 months of a gym membership. I signed up for a great gym for $30 per month. I am saving them money.
posted by KB.Boston_implant.By way of NY at 7:46 PM on January 22, 2008

In South Africa, our plan not only pays for membership, they also give incentives for attendance (huge discounts on holiday travel, to name one). Also, they monitor the results of the blood pressure machine at the gym. My partner had the insurance company nurse call the other day, his BP has been elevated lately (BP isn't about being fat. Mine is good, I'm lazy and heavy. He works out, keeps his weight lower. But has BP issues in his family).
posted by Goofyy at 3:14 AM on January 23, 2008

My insurance (PruHealth) in the UK have an interesting plan. If you go to the gym you join through them more than 2 times a week, it's free... So, I'm only paying my health insurance premiums to go to the gym AND get health insurance.

They also have other incentives like, getting a physical, doing a stress management course, maintaining a BMI, lowering your BP, even buying vegetables with an affiliated rewards card at a local supermarket earns you reward points inside the health fund scheme which will reduce your premiums over time.

The idea is that, the more you exercise and eat right and manage your stress, the less likey you are to claim. Sounded too good to be true but, for £30 a month, i get health cover at hospitals, doctors, dentists and some other sundries as well as a gym membership and, the more incentives I do, the more my premium goes down. It should be down to £20 by Jan next year.

Also, going to the gym earns you bonus points - Double Bonus!
posted by moocheen at 7:18 AM on January 23, 2008

Some health plans do. Some don't. Consider that some health plans don't even cover the cost of insulin, test strips and needles needed to treat type 1 diabetes.
Some employers are more progressive about this than others. There are companies devoted to employee health and wellness who administer programs online and over the phone to complement health plan inititatives like weight loss and smoking cessation. Some employers even have on-site gyms and health professionals like dietitians and nurses to help. Some employers see their employees health as a preventive issue; some as an acute issue (treat problems as they arise). Preventive is usually more expensive unless your population is 20-35 year old primarily male people.
It all comes down to money... even for the diabetes supplies. It's just a money thing.
posted by FergieBelle at 5:53 PM on January 23, 2008