FAIR Health Consumer Access

Wellness Programs: Coverage for Promoting Healthy Living

Healthy lifestyle behaviors include regular exercise and nutritious eating. Are you looking to carry out such behaviors but unsure how to start? If so, you may want to explore the wellness programs offered by your employer or health insurance plan. You may wonder: What is a wellness program? How do you know if you can take part in one? Will you get a reward?

This article will tell you about wellness programs that employers and health insurers may provide. You’ll learn how to join them and how you may be rewarded for your efforts.

What Is a Wellness Program?
Wellness programs are resources designed to promote and improve health. They’re typically offered by employers, though they can also be offered to individuals directly through their insurance plans. Workplace wellness programs often involve financial incentives for workers to take part in or complete the program. These incentives may be gift cards, cash, fitness devices, contributions to health-related savings accounts or health insurance discounts. Some examples of wellness programs include:

• Gym memberships at your local gym at a discounted rate;
• Tobacco cessation programs to help you quit smoking through counseling sessions and nicotine replacement products such as nicotine gum;
• Healthy lifestyle coaching, which lets you work with a wellness coach and set goals to improve your health;
• Diabetes management programs to help you handle your diabetes by giving you food and exercise guidelines; and
• Mindfulness programs, which can help you become more in tune with your mind and body. This could potentially improve your mental health through, for example, meditation centers and online meditation.

Wellness programs differ from preventive services, such as vaccines and screenings. Preventive services can help you avoid certain diseases and catch others in their early stages. Wellness programs can help you adopt a healthy lifestyle. See Preventive Services: Coverage and Costs in this issue.

According to a 2019 Kaiser Family Foundation report, more than half of small firms and 84 percent of larger firms offer health and wellness programs to their employees. To learn more about the wellness benefits you have access to, contact your employer or insurance plan.

Benefits of Wellness Programs
Wellness programs are designed to cut healthcare costs for both workers and employers. Consumers may gain from wellness programs by lowering their risks for getting sick by losing weight or stopping smoking. Being sick less often could lead to lower out-of-pocket medical costs for consumers. Also, taking part in wellness programs may lower health insurance premiums for consumers. Wellness programs may also boost employees’ moods. Employers may gain from wellness programs because the programs can lead to fewer employee sick days and increased productivity while at the office.

Different Types of Wellness Programs
There are two types of wellness programs: participatory and health-contingent. Participatory wellness programs are typically open to anyone who would like to take part in them. Some of these programs don’t offer rewards. Others do, but don’t set rules for collecting an award based on reaching specific health goals. It’s up to your employer or health insurance issuer to choose to reimburse or reward you for taking part. Examples include joining a gym at a cheaper price or taking part in diagnostic testing for a reward.

By contrast, health-contingent wellness programs reward people for achieving outcomes related to personal health status. There are two types of health-contingent programs: activity-only and outcome-based. Activity-only programs typically offer rewards for completing a health-related activity. Examples of activities might be exercising more or following a diet program. Outcome-based programs offer rewards for achieving defined health outcomes, such as becoming tobacco-free or losing weight.

How to Join a Wellness Program
There are many ways to join a wellness program. You can join a wellness program through your employer. You can do that as part of your group health plan or as a free-standing benefit. If you’re joining one through your employer, information on what’s offered can be found in your employee benefits package. You can also join a wellness program through your individual health insurance plan. Contact your health insurance company to find out which wellness programs and benefits your health plan offers. If you’re out of work or not insured, you can gain access to a wellness program by enrolling in insurance. There are different ways to buy insurance. You can buy insurance coverage directly from an insurer. Or you can buy it through the Health Insurance Marketplace (or Exchange). See our article on the Affordable Care Act.

Medicare and Medicaid don’t offer wellness programs in the same way as private health insurance. Original Medicare, a government health plan for seniors 65 and older, doesn’t cover gym memberships or fitness programs. But you may be able to access these services through the extra coverage offered by Medicare Advantage plans and other Medicare health plans. You can call your additional Medicare health plan to see if it covers gym memberships or fitness programs. Traditional wellness programs are not covered by Medicaid.