A Door Opens at CMS

The inclusion of physical activity assessments in Medicare is part of a broader shift underway at the Centers for Medicare & Medicaid Services (CMS). As policymakers grapple with rising chronic disease, an aging population, and unsustainable healthcare costs, there is growing recognition that prevention, functional health, and physical activity must play a more central role in federal health policy.

That momentum is being reinforced by new leadership across federal health agencies in the United States. With Robert F. Kennedy Jr. serving as Secretary of Health and Human Services and Dr. Mehmet Oz leading CMS, the Make America Healthy Again (MAHA) agenda is opening doors for more serious consideration of prevention, lifestyle interventions, and non-clinical approaches to improving population health.

In 2026, we expect CMS to take a more active posture on both traditional Medicare and Medicare Advantage—exploring how physical activity can be better integrated into care models, benefit design, and chronic disease strategies. HFA is preparing now to engage early, consistently, and constructively to help shape those discussions and ensure the fitness industry is positioned as a credible, solutions-oriented partner.

Lessons from Medicare Advantage—And Why They Matter

Today, millions of seniors already access fitness and physical activity programs through Medicare Advantage via third-party benefit providers. These programs have introduced countless older adults to fitness facilities and helped normalize physical activity as part of healthy aging.

At the same time, we know—directly from operators—that these programs can be challenging to administer and sustain. Reimbursement rates, utilization patterns, operational complexity, and alignment with facility business models all matter. Expanding access without addressing these realities risks creating programs that look good on paper but strain operators in practice.

That experience is shaping how HFA approaches the next phase of Medicare policy discussions.

Avoiding the Pitfalls of Coverage Design

As policymakers explore pathways for broader Medicare coverage of physical activity, it is critical to get the "how" right—not just the "what". One of the biggest risks is establishing payment and participation models that require direct, traditional provider-style relationships between individual fitness operators and Medicare.

For many facilities—particularly small, independent clubs, studios, and community-based operators—direct billing, credentialing, compliance, and audit requirements would be prohibitively complex. If coverage models assume operators can function like clinical providers, access will narrow rather than expand, and participation will be limited to only the largest or most resourced organizations.

But the rationale here is not solely about protecting operators—it is about protecting beneficiaries.

Medicare beneficiaries need broad, flexible access to physical activity options that allow them to move in ways that are comfortable, familiar, and motivating for them. We know that the physical and mental health benefits of movement do not come from overly prescriptive, one-size-fits-all programs; they come from consistency, choice, social connection, and meeting people where they are.

If coverage models restrict participation to narrow program designs or limited delivery settings, they risk undermining engagement and long-term adherence—ultimately reducing the very health outcomes Medicare is trying to improve.

HFA is focused on ensuring that future coverage pathways:

● Do not require fitness facilities to operate as Medicare providers or navigate burdensome direct billing relationships;

● Preserve beneficiary choice by supporting diverse activity options across facility types and program models; and

● Leverage intermediaries, partnerships, or value-based approaches that align with how operators actually deliver services.

Done right, Medicare coverage can expand access, respect individual preferences, and help seniors get—and stay—physically active. Done poorly, it risks limiting choice and participation for both operators and beneficiaries alike.