Newsletter from Theresa Cangemi @ Retirement Health Plans Made Simple (sm)

The Medicare Insurance Lady

Celebrating since 2008 as a Medicare Insurance Specialist

(This Is NOT A Government Newsletter)

📧 tcangemi@RetirementHPMS.com

📱 Cell: 315.727.4933

New Name: “RETIREMENT HEALTH PLANS MADE SIMPLESM




MEDICAL SECTION – CHANGES and BENEFITS: AETNA FITNESS ALLOWANCE –

Items No Longer Included


-Renew Active® – BENEFITS as a reminder

- Silver&Fit®    – BENEFITS as a reminder

- SilverSneakers®– BENEFITS as a reminder




ANNOUNCEMENTNOW LICENSED in NY and Florida.

If you are moving and relocating to Florida, I can help you find a new Medicare insurance plan. Please give me a call. Referrals to friends and family are always welcomed and appreciated! 

Keep reading!

Theresa Cangemi CSA, CLTC

"The Medicare Insurance Lady" 

MEDICAL SECTION


CHANGES to AETNA FITNESS ALLOWANCE and BENEFITS for the SilverSneakers® GYM MEMBERSHIP


I want to make sure that my clients understand how their gym memberships are working.  I will be discussing Aetna, UHC, Humana, and Excellus BCBS below


I received a call from a NY client this week that was not familiar with the new Fitness Allowance benefit Aetna included in their Medicare Advantage plan for Upstate, NY area, for 2024.


So, let’s dig in there first: 

The new 2024 Aetna benefit is called Fitness Allowance.  


In the Summary of Benefits (page 12):

You can read for yourself the Gym membership AND the Fitness Allowance being offered. You have access to both in 2024. 

Summary: Click Here

The Fitness Allowance works as a reimbursement. Another words, you pay for the activity upfront, get a paid itemized receipt, and then submit the receipt with an Aetna claim form to get reimbursed up to the allowance. 


In this discussion the allowance is $600 but could be different in different areas and different Medicare Advantage plans. 


The gym membership is at $0 cost.  


********************************


The CHANGES (below) were MANDATED BY CMS (Centers for Medicare and Medicaid) regarding Aetna Fitness Allowance – April 2024

Effective immediately, the Aetna fitness benefit can no longer be used for the following items: 



• Athletic shoes (all types) 

• Camping tents 

• Fishing rods 

• Hiking poles 

• National and state park fees 


What types of purchases or services do not qualify for reimbursement?



This benefit cannot be used for reimbursement for items including:


• Fees or dues for social clubs, country clubs, gun clubs, state and national parks, and shooting ranges


• Athletic clothing (including shoes)


• Edible items such as protein shakes, bars and supplements


• Bicycle maintenance and repair


• Orthopedic shoes and/or inserts, knee/ankle braces


• Electronic music devices or subscriptions to digital music services


• Online and in-person weight management programs (e.g., Noom, Weight Watchers, etc.)


• Items, services, and supplies covered by Original Medicare, including but not limited to, physical therapy, chiropractic and acupuncture or massage therapy services


• Purchases made with resellers (e.g., Facebook Marketplace, eBay, Poshmark, garage, yard and estate sales)


• Hunting supplies


• Licenses/certifications for hunting and firearms



• Camping tents, fishing rods, hiking poles

Members are covered for a basic membership to any SilverSneakers® participating fitness facility.


If a member does not reside near a participating facility, or prefers to exercise at home, online classes and at-home fitness kits are available. Members may order one fitness kit per year through SilverSneakers. 


Members also have access to online enrichment classes to support health and wellness, as well as mental fitness. Health and wellness classes include, but are not limited to cooking, food and nutrition, and mindfulness. 


Mental fitness classes include, but are not limited to new skills, organization, self-help, and staying connected. These classes can be accessed online by visiting www.SilverSneakers.com



The fitness allowance benefit can also be used to cover fees associated with extra features at SilverSneakers facilities (e.g., fees associated with Pilates, water aerobics, use volleyball or racquetball courts).


NEED A Fitness Allowance REIMBURSEMENT FORM?

Reimbursement FORM

To request reimbursement, members must complete and submit the fitness DMR form within 60 days of the date of purchase, along with any required itemized receipts.


Mail the completed form and the original itemized receipts to the address on their Aetna member ID card.

Once approved, members will receive a check in the mail for repayment of the covered services up to the benefit amount. It can take up to 45 days for members to receive payment after all required information is received.


Questions 

Questions, please call at the number on the back of your ID card

8AM–8PM, 7 days a week. Also, for SilverSneakers: 1 888 423 4632 (TTY: 711)


MORE INFORMATION – about Aetna SilverSneakers® gym membership (located in the Evidence of Coverage (EOC) document; pages 53-55):

EOC document

REMINDER FOR UNITED HEALTHCARE:


For UNITED HEALTHCARE – Gym Membership is called Renew Active® (from SOB)


$0 copay for Renew Active®

• A free gym membership at a gym near you 

• Access to the largest national network of gyms and fitness locations 

• Access to many premium gyms and fitness locations 

• An annual personalized fitness plan 

• Members who need help can bring a workout assistant to the gym 

• Access to thousands of on-demand workout videos and live streaming fitness classes 

• Social activities at local health and wellness classes, clubs and events 

• Online Fitbit® Community for Renew Active — no Fitbit device needed 

• Access to the AARP® Staying Sharp® App


The Fitness Allowance is new to Aetna in 2024 and is NOT a United Healthcare option in 2024

REMINDER FOR HUMANA


For HUMANA – Gym Membership is called SilverSneakers® (from EOC)


$0 copay for SilverSneakers® 

Fitness program SilverSneakers® is a fitness program for seniors that is included at no additional charge with qualifying Medicare health plans. 

Members have access to participating fitness locations across the country that may include weights and machines plus group exercise classes led by trained instructors at select locations. 

Access online education on SilverSneakers.com, watch workout videos on SilverSneakers On-DemandTM or download the SilverSneakers GOTM fitness app for additional workout ideas. 

Any fitness center services that usually have an extra fee are not included in your membership.


The Fitness Allowance is new to Aetna in 2024 and is NOT a Humana option in 2024

REMINDER FOR EXCELLUS BCBS


For EXCELLUS BCBS – Gym Membership is called Silver&Fit® (from EOC)


$0 copay for Silver&Fit

Health and wellness education programs Silver&Fit® Fitness Program ·

Silver&Fit participating fitness centers provide access to standard services and amenities. In addition, some offer special programs and classes exclusive to Silver&Fit members.

The Silver&Fit Home Fitness Program provides a choice of one kit per year.

There is no annual fee for one Home Fitness Kit. You can choose BOTH membership at a participating fitness center AND 1 Home Fitness Kit.


Silver&Fit provides an annual reimbursement allowance towards paid memberships at non-participating fitness clubs and exercise centers. Contact Silver&Fit Customer Service for more information.   


You will be reimbursed up to an annual allowance of $150. You cannot simultaneously enroll in an in-network and an out-of-network fitness facility. You can change facilities each month. Changes are effective on the first day of the following month.


Payment requests should be submitted after that month has passed, but within 90 days of the end of the calendar year. Future months of membership cannot be processed (for example, submit receipts for January on or after February 1st). 

To be reimbursed, submit an out-of-network reimbursement form, a fitness facility member verification form, and paid receipts directly to Silver&Fit Customer Service.

Send payment requests by email to: Fitness@ashn.com or mail to: Silver&Fit, PO Box 509117, San Diego, CA 92150-9117


Contact Silver&Fit Customer Service at 1-888-797-7925 (TTY/TDD users call 711). Monday through Friday, from 8 a.m. to 9 p.m.


Healthy Aging Coaching: 

You can participate in sessions by phone, video, or chat with a trained coach where you can discuss topics like exercise, nutrition, social isolation, and brain health.

There is no annual fee for Healthy Aging Coaching.


The Fitness Allowance is new to Aetna in 2024 and is NOT a Excellus BCBS option in 2024

New October 2022 CMS (government) REQUIRED disclaimer:


“Every plan may not be available in your area. Any information we provide is limited to those plans we do offer in your area.” “Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.” 


***********************************************************************

Theresa’s disclaimer:  I DO OFFER Medicare Insurance plans from MANY different insurance companies; in NY and Florida.


The available insurance plans will depend on your state, zip code, and eligibility.

* This article is for information purposes only. I don’t recommend, support, or diagnose any featured writer or article. I am not a doctor. Your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. You and your doctor will know your own health best.

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