Why Point32Health pays members $150 to go to the gym

As health insurers roll back benefits, some see value in keeping a fitness benefit around.

Take nonprofit Massachusetts-based payer Point32Health. It was formed by the merger of Harvard Pilgrim Health Care and Tufts Health Plan, which collectively have about 2 million members in the Northeastern US, including about 1 million commercial members.

Like most payers, Point32Health is struggling with high medical and pharmacy costs. It reported a $301 million operating loss for 2025, per a news release, and $382 million for 2024, per the Boston Business Journal. The company also cut more than 350 jobs in 2025. But even as it took cost-cutting steps in some areas, it still offered fitness and wellness reimbursement for gym memberships and related fees for many commercial members, and actually expanded the program in 2024.

The reimbursement is $150 per year for individuals and $300 for families in all its fully insured plans, and the amount is customizable for self-insured commercial plans, Raj Hazarika, VP and chief medical officer for commercial products, told Healthcare Brew. He added that Point32Health the payer has kept offering the benefit due to participant interest as well as to stay in line with other payers.

“It’s almost like this [benefit] is the expectation at this point. To not have it would be a concern,” he said.

Comprehensive data on commercial plan supplemental offerings isn’t widely available, but healthcare consulting firm Avalere Health found fitness benefits are offered by 87.1% of non-special-needs Medicare Advantage (MA) plans in 2027.

Growing interest

Both Tufts and Harvard Pilgrim plans have reimbursed traditional gym and fitness center memberships for over 20 years, Hazarika said.

Participation grew after Point32Health plans began reimbursing a range of other wellness products like home fitness equipment, select nutrition programs like MyFitnessPal, and certain mindfulness programs like the Calm app in 2024, he said.

In 2025, 38,830 Point32Health subscribers submitted claims for a fitness reimbursement. That’s 12% of all its eligible members, Hazarika said, a figure that has increased over the last few years.

“We’ve definitely had a lot more people be interested in healthy living, healthy nutrition, more physical activity, especially with the availability of GLP-1 drugs in general, and people are more aware now of the need to be proactive about their health,” Hazarika added.

Designing sustainable benefits

The payer has kept this benefit sustainable through a design that minimizes administration costs and encourages habit-forming behavior.

To get gym reimbursement on the Harvard Pilgrim Health Care plan, for example, enrollees must have been members of both the plan and their gym for at least four months.

Hazarika said he believes this time minimum is in line with other health insurers that offer fitness reimbursement. It also encourages a pattern of healthy behavior instead of “someone signing up for an expensive one-time class and submitting for reimbursement.”

In addition, it reduces the cost of administering the program.

“We would rather do fewer of those reimbursements on a yearly basis, up to the maximum allowable amount, of course, rather than a whole number of small claims,” he said.

Cut or keep?

Each year, the payer reevaluates whether it makes sense to offer fitness reimbursement and other perks, Hazarika explained.

Even though the fitness reimbursement program stayed, Harvard Pilgrim commercial products and Tufts Health Direct ended GLP-1 coverage for weight loss for many plans on Jan. 1, 2026, a move other insurers and employers are making, too. (Some large commercial group employer customers can still include it in their plans, per a 2025 notice from Point32Health to providers.)

Removing GLP-1 coverage was one of several “tough decisions” the payer made amid cost challenges, Hazarika said.

Name-brand GLP-1s have a list price of $499 to $1,349.02 per month, according to an October article from Forbes Health.

Fitness reimbursement of $150 per year per member is a relatively small “slice of the pie” when it comes to overall medical expenses, even though “it does add up to quite a bit of money,” Hazarika said.

Blue Cross Blue Shield of Massachusetts offers a similar $150 annual reimbursement per contract, for which 2 million of its 3 million total members are eligible, Kelsey Pearse, spokesperson for Blue Cross MA, told us via email.

Other health plans partner with companies like Optum Health-backed One Pass or SilverSneakers, both of which offer subscription programs with free or discounted gym memberships and workout classes.

The Advantage

For MA plans, fitness programs have become almost ubiquitous.

An Avalere Health analysis prepared for SilverSneakers’s parent company, Tivity Health, in 2021 found participants had 16% lower medical costs compared to MA members who didn’t participate in SilverSneakers, according to a Tivity Health press release.

Meredith Freed, senior policy manager for KFF’s Program on Medicare Policy, told Healthcare Brew that fitness benefits are widely offered across MA plans. KFF has not published a 2027 analysis yet, but its 2026 analysis of MA plans found a dip from a 99% peak in 2023 to 91% of plans offering it in 2026. Along with fitness, some other benefits have dropped by more than 20 percentage points since their 2023 peak.

“Even though it’s declined slightly from the last year, [fitness is] still one of the most widely available benefits besides dental, vision, and hearing. It has been for a long time,” Freed said.

Freed cautioned, however, that this analysis didn’t look at the “generosity” of these benefits.

“I’ve seen a lot of them only cover…basic memberships,” Freed said. “Some plans do offer reimbursement if you go out of the gym network. But the reimbursement for that, at least that I’ve seen in some of the plans I looked at, is fairly low.”

One Pass CEO Tom Wiffler told Healthcare Brew the program hasn’t made any significant cuts despite market headwinds.