While the gym memberships and other wellness benefits are widely seen as a way to improve enrollee health and reduce healthcare costs, Trivedi says that represents a skewering—whether intentional or not—of the intent of the Medicare Advantage program.
"The hope was that plans would compete against each other on the basis of their ability to improve care and reduce costs and not on their ability to attract the healthy and exclude the sick," he says. "We don't know the rationale for why plans offer these memberships, but the effect is that the plans get a healthier slice of the Medicare population."
"There are lots of reasons to offer fitness memberships. It could be to improve the health of existing enrollees or to retain enrollees who value that service," he says. "In general policy makers are uncomfortable with the notion that plans are able to compete on the ability to cherry pick the healthiest enrollees."
Robert Zirkelbach, spokesman for America's Health Insurance Plans, contends that " [one] from a methodological standpoint they are relying on self-reported health status and two they acknowledge that some of the data they are looking at is from before the enhanced risk adjustment of 2004. There is risk adjustment system in place designed to address the adverse selection."