Does Medicare Cover Shoes and How Does It Work?
Does Medicare cover shoes? Get clear answers on therapeutic footwear coverage, eligibility, and the steps to obtain your pair.
Medicare does provide coverage for certain therapeutic footwear and inserts, specifically for individuals with diabetes who meet particular medical criteria. This coverage falls under Medicare Part B, which handles durable medical equipment (DME).
Covered Footwear and Inserts
Medicare Part B covers specific types of therapeutic footwear and inserts, primarily known as diabetic shoes. These include one pair of either custom-molded shoes or extra-depth shoes per calendar year. The purpose of these specialized shoes is to help prevent lower-limb ulcers, amputations, and other severe complications for individuals managing diabetes.
Beyond the shoes themselves, Medicare also covers inserts that fit within this therapeutic footwear. For custom-molded shoes, two additional pairs of inserts are covered annually. If extra-depth shoes are provided, three pairs of inserts are covered each calendar year. It is important to note that regular comfort shoes, athletic shoes, or ordinary footwear, even if recommended by a physician, are not covered under this benefit.
Qualifying for Coverage
To qualify for Medicare coverage of therapeutic shoes and inserts, an individual must have diabetes and present with specific foot conditions. These conditions may include peripheral neuropathy with evidence of callus formation, a history of foot ulceration, pre-ulcerative calluses, a previous amputation of part of the foot, or a foot deformity. Poor circulation is another qualifying condition that can establish medical necessity for this specialized footwear.
A key requirement is that a physician managing the patient’s diabetes must certify the medical necessity for the therapeutic shoes and inserts. This certifying physician, who must be an M.D. or D.O., attests that the patient is under a comprehensive plan of care for their diabetes. The medical records must contain documentation from an in-person visit within six months prior to the delivery of the shoes, detailing the qualifying foot condition and the management of the patient’s diabetes. Furthermore, the certifying physician must sign a certification statement on or after the date of this visit and within three months before the shoes are delivered.
Obtaining Your Shoes
After meeting the medical and documentation requirements, the process of obtaining therapeutic shoes involves several practical steps. First, individuals must select a supplier that is enrolled in Medicare and accepts assignment. This ensures that the supplier agrees to Medicare’s approved amount for the footwear and will not bill the patient for more than the Medicare deductible and coinsurance. Medicare-approved suppliers often include podiatrists, orthotists, prosthetists, or pedorthists.
The patient will present the completed prescription and necessary medical records to the chosen supplier. A professional fitting process will then take place to ensure the shoes and inserts are appropriate for the patient’s needs. Medicare Part B typically covers 80% of the Medicare-approved amount for the shoes and inserts once the annual Part B deductible has been met. For 2025, the Part B deductible is $257, and the patient is responsible for the remaining 20% coinsurance.
If a claim for therapeutic shoes is denied, beneficiaries have the right to appeal the decision through a multi-level process. This involves explaining why they disagree with the decision and providing supporting evidence, often with assistance from their doctor.