Does Medicare Pay for Custom Orthotics?

Understanding Medicare benefits for specialized medical equipment like custom orthotics can be complex. Custom orthotics are devices designed to support, align, prevent, or correct deformities of the foot or ankle. This article clarifies Medicare’s coverage policies for these devices, helping beneficiaries navigate their healthcare options.

Conditions for Medicare Coverage

Medicare Part B may cover custom orthotics, particularly therapeutic shoes and inserts, when they are deemed medically necessary for specific conditions. This coverage primarily applies to individuals with severe diabetic foot disease, including those with a history of foot ulcers, amputation, or significant foot deformities related to diabetes.

Beyond diabetes-related needs, Medicare Part B can also cover orthotics classified as braces, such as ankle-foot orthoses (AFOs) and knee-ankle-foot orthoses (KAFOs), if medically necessary. These devices must be rigid or semi-rigid and support a weak or irregularly formed body part, or restrict motion in a diseased or injured area. The primary requirement for coverage is a physician’s determination that the custom orthotics improve function or prevent further complications.

Required Documentation and Provider

Securing Medicare coverage for custom orthotics requires specific documentation and adherence to provider requirements. A physician’s prescription is required, clearly stating the medical necessity for the orthotics based on a qualifying condition. This prescription must be supported by medical records, including diagnostic test results, detailed medical history, and established treatment plans that justify the need for the device.

The prescribing physician, such as a podiatrist or orthopedist, must be enrolled in Medicare. The custom orthotics must also be provided by a Medicare-enrolled supplier, such as an orthotist, prosthetist, or pedorthist, who agrees to accept Medicare assignment. Accepting Medicare assignment means the provider agrees to accept the Medicare-approved amount as full payment for the service, reducing the potential for unexpected out-of-pocket costs for the beneficiary.

Beneficiary Cost-Sharing

Even when custom orthotics are covered by Medicare, beneficiaries incur financial responsibility. For items covered under Medicare Part B, the beneficiary is responsible for the annual Part B deductible. In 2025, this deductible is $257. After meeting the deductible, Medicare generally pays 80% of the Medicare-approved amount for the orthotics, leaving the beneficiary responsible for the remaining 20% coinsurance.

The Medicare-approved amount is the maximum payment Medicare sets for a particular service or item. If a provider does not accept Medicare assignment, they may charge more than this approved amount, and the beneficiary would be responsible for the difference. Supplemental insurance plans, such as Medigap policies or Medicare Advantage plans, may help cover some or all of these out-of-pocket costs, reducing the beneficiary’s financial burden.

What Medicare Does Not Cover

Medicare does not cover all types of foot support devices. Non-custom, over-the-counter shoe inserts or comfort-oriented insoles are not covered, as they are not considered medically necessary durable medical equipment or therapeutic shoes. Orthotics prescribed solely for general foot pain or discomfort, without meeting medical necessity criteria linked to specific qualifying conditions, will also not be covered.

Regarding replacement, Medicare has frequency limits for covered orthotics. For individuals with qualifying conditions, Medicare generally covers one pair of custom-molded shoes and inserts each calendar year. Additionally, two extra pairs of inserts for custom-molded shoes or three pairs of inserts for extra-depth shoes may be covered annually if medically necessary. Replacement beyond these limits or for reasons not tied to medical necessity may not be covered.