Does Medicare Pay for Foot Orthotics?
Navigate Medicare's specific coverage for medical supplies. Learn eligibility, covered items, and the process to secure your benefits.
Medicare’s role in covering healthcare expenses is extensive, but understanding its specific provisions for medical equipment and services can be complex. The program aims to support beneficiaries with necessary items. However, coverage is not always straightforward. Specific criteria and medical necessity determine whether an item or service qualifies for financial assistance.
Understanding Medicare Coverage for Foot-Related Items
Medicare Part B covers certain foot-related items, specifically therapeutic shoes and inserts, primarily for individuals with diabetes who meet particular conditions. While general foot orthotics, such as custom or off-the-shelf shoe inserts for common foot pain, are typically not covered, the focus shifts to preventive care for serious diabetes-related foot complications.
For those with diabetes, Medicare Part B may cover one pair of custom-molded shoes, including inserts, and two additional pairs of inserts each calendar year. Alternatively, it can cover one pair of extra-depth shoes and three pairs of inserts annually. Shoe modifications can also be covered as a substitute for inserts, providing flexibility in addressing specific foot needs. This benefit is designed to help prevent lower-limb ulcers and amputations in eligible individuals.
Qualifying for Coverage
To qualify for Medicare coverage of therapeutic shoes and inserts, a beneficiary must have diabetes. The need for these items must be certified by a physician. The physician treating the patient’s diabetes must document specific foot conditions related to diabetes. These conditions include a history of partial or complete foot amputation, previous foot ulceration, or pre-ulcerative calluses.
Additional qualifying conditions include nerve damage due to diabetes with evidence of callus formation, poor circulation in the feet, or a foot deformity. The certifying physician must confirm they are treating the patient under a comprehensive diabetes care plan. A standard written order from the prescribing practitioner, following an in-person visit within six months prior to the delivery of the shoes or inserts, is also a requirement.
Costs and Procurement Steps
When Medicare Part B covers therapeutic shoes and inserts, it typically pays 80% of the Medicare-approved amount. The beneficiary is responsible for the remaining 20% coinsurance after meeting the annual Part B deductible. For 2025, the annual deductible for Medicare Part B is $257.
To obtain covered items, beneficiaries must work with suppliers enrolled in Medicare who accept assignment. This means the supplier agrees to accept the Medicare-approved amount as full payment, ensuring the patient is only responsible for their deductible and coinsurance. The supplier will typically handle the fitting of the shoes or inserts and submit the claim directly to Medicare for reimbursement.