Olympic Athletes Patch Together Elite Health Coverage

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By Victoria Pelham

Olympians like Justin Olsen stretch and skate their bodies to their limits. And just two days before Team USA’s bobsledding athletes took to the ice in PyeongChang for Winter Olympic training the pilot’s appendix hit his.

The athlete, who had an emergency appendectomy in South Korea this week, may or may not make it back in time for competition.

Ski racer Lindsey Vonn, another household name, missed out on the last Winter Olympics in Sochi entirely with a right knee injury: She’s set to return this year.

The international spectacle every four years shines a light on the elite athletes’ physical health. Outside of the Olympics, they’re kept in tip-top shape by a complex patchwork of health care and coverage through an exclusive Olympian health insurance plan and private company endorsements.

Some worry that framework still might not be enough, with many but the most successful slipping through the cracks.

A Health Plan for Olympians

The U.S. Olympic Committee’s Elite Athlete Health Insurance program offers medical benefits to select participants in the games, with each governing sports federation doling out a limited number of plans based on their own strategies.

The coverage is run as a preferred provider organization plan through Highmark Blue Cross Blue Shield, according to Team USA.

It currently insures 925 Olympians and Paralympians, according to Highmark spokesman Aaron Billger. Those athletes in turn can receive care at 92 percent of U.S. doctors and 96 percent of U.S. hospitals, he told Bloomberg Law in an email.

Neither the U.S. Olympic Committee nor Highmark offered further details about what the plan includes.

The USOC did not respond to requests for comment by press time.

But selected beneficiaries are subject to a $25,000 sport injury deductible, according to the team. Each sport’s board carries separate accident insurance for injuries that take place during competitions such as trials and national championships.

Competitive professional athletes are higher-risk for injuries as they put pressure on their bodies through their sports, experts said. At the Winter Olympics, athletes tend to hurt their knees most as they make triple axel jumps and heavy landings on skis and skates.

A Performance Model

“The model is completely different” for elite athletes compared with an average patient, Dr. Miho Tanaka told Bloomberg Law. “You have almost a concierge physician who works for that team who is dedicated to you.”Health insurance tends to be “a little bit more workers’ compensation,” Tanaka, an assistant professor of orthopaedic surgery and director of the Women’s Sports Medicine Program at Johns Hopkins University, added. “Everything is designed for performance, and it’s actually part of your job and necessitates your ability to do things.”

Preventive medical care and athletic training are also priorities among top-tier athletes as they wear down their bodies with strenuous sporting, those familiar said.

Attempts to find out how Team USA Winter Olympics sport governing bodies including speed skating and bobsled currently determine health policy qualification were unreturned or rerouted to the USOC.

But a document obtained by Bloomberg Law shows one Summer Olympics sport is designating its 2018 USOC health policies to athletes in tiers one through three, as well as those in the team’s talent protection program, and resident athletes at a selected training facility. The roughly 40 to 50 spots would be determined based on the tiers, which offer the highest level of benefits for those who ranked in the two most recent world championships or Olympics.

Elite athlete health insurance is really only available for a small portion of Olympic athletes, Jill Pilgrim, executive director and general counsel for the Track & Field Athletes Association, told Bloomberg Law. Pilgrim, also an attorney with Pilgrim & Associates Law Offices in New York, has served in the past as staff liaison for USA Track & Field to USOC and national governing body committees.

The rest of the Olympians, and those hoping to reach that level, have to make do with what’s available to them.

Missing Link?

Some who excel and reach the highest ranks score contracts with clothing companies or other sponsors that pay enough to buy individual coverage. College team athletes working toward an Olympics goal often are insured through their universities, while under the Affordable Care Act, those who can often stay on their parents’ health insurance until age 26, Pilgrim said.

“Once they’ve already achieved a lot, been a high performer, and get a contract, they fall off a cliff and have no medical coverage,” she said, noting that they’re not employees of any company.

Pilgrim said that she’s heard about former Olympians with injuries who don’t have medical coverage and can’t afford treatment.

She warned that the U.S. is missing out on highly skilled athletes and competitors who are being “left out” because of health issues that can’t be treated. Further, some Olympians don’t notify staff of pre-existing health problems so as to not miss out on the Olympic dream.

It’s a critical problem that needs to be addressed by ensuring funds make it down to the competitors and not just the top of the relevant sports organization, she said. Otherwise, sponsors tout their Team USA athletes every four years but don’t back them in the three-and-three-quarters-year build-up to the games.

And Team USA has less medical coverage and services than other competing nations and athletes they’re up against, Pilgrim cautioned. This could lead to foreign athletes studying and playing in the U.S. in their college years being enticed away to other teams for the Olympics, she said.

The “support needs to go deeper,” she said.

“Our best athletes may have left the sport because they didn’t have medical coverage or they weren’t making enough to support themselves,” Pilgrim said.

Celebrated skier Vonn, who’s battled years of health struggles, said in a Feb. 7 tweet that the athletes aren’t government-funded and noted they “rely on donations and sponsors to support our programs. Which is why I am such an advocate for promoting ski racing and I continue to help fundraisers for our team.” She also runs a foundation.

To contact the reporter on this story: Victoria Pelham in Washington at vpelham@bloomberglaw.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bloomberglaw.com

Copyright © 2018 The Bureau of National Affairs, Inc. All Rights Reserved.

Request Health Care on Bloomberg Law