Does Medicare Pay for Orthotics for Shoes?

Medicare, the federal health insurance program, helps millions of Americans manage their healthcare needs. For beneficiaries, understanding Medicare’s coverage for orthotics, especially for shoes, involves specific criteria, cost responsibilities, and procedural requirements.

Medicare Coverage for Orthotics

Medicare Part B covers certain orthotics for shoes when medically necessary. This coverage primarily extends to individuals diagnosed with diabetes who have severe diabetes-related foot disease. Conditions such as diabetic neuropathy or Charcot foot often qualify a beneficiary for therapeutic shoes and inserts designed to prevent further complications.

Medicare Part B specifically covers the furnishing and fitting of therapeutic shoes and inserts. Each calendar year, a beneficiary may receive one pair of either extra-depth shoes or custom-molded shoes and inserts. Medicare also covers up to three pairs of inserts for extra-depth shoes and two additional pairs of inserts for custom-molded shoes within the same calendar year. Modifications to shoes can also be covered as an alternative to inserts. Beyond footwear, Medicare Part B also covers other medically necessary orthotics, such as ankle-foot orthotics (AFOs) and knee-ankle-foot orthotics (KAFOs), which are external devices that support or align a body part.

Understanding Your Costs and Providers

Medicare Part B outlines the financial responsibility for covered orthotics. After meeting the annual Part B deductible, which is $257 in 2025, beneficiaries typically pay 20% of the Medicare-approved amount. For example, if a covered orthotic costs $600, a beneficiary would pay $120 after their deductible is met, with Medicare covering the remaining $480. This cost-sharing applies if doctors and suppliers are enrolled in Medicare and accept assignment, meaning they agree to accept the Medicare-approved amount as full payment.

Medicare Advantage Plans are offered by private companies approved by Medicare. These plans must provide at least the same level of coverage as Original Medicare. However, Medicare Advantage plans may have different cost-sharing rules, network restrictions, or requirements for prior authorization. Beneficiaries with a Medicare Advantage plan should contact their plan directly to understand their specific coverage details.

Healthcare professionals and suppliers providing orthotics must be enrolled in Medicare for services to be covered. This includes licensed podiatrists, orthotists, prosthetists, pedorthists, or other qualified medical doctors. It is important to confirm that both the prescribing doctor and the supplier accept Medicare assignment before obtaining orthotics. If a supplier does not accept assignment, they are not limited to the Medicare-approved amount and can charge more, leaving the beneficiary responsible for the difference.

The Process for Obtaining Covered Orthotics

Obtaining Medicare-covered orthotics for shoes begins with a visit to a qualified physician, such as a podiatrist or endocrinologist. This physician must certify the medical necessity of the therapeutic shoes or inserts, providing a clear diagnosis and detailed medical documentation for the required orthotics, especially for severe diabetic foot disease.

Once medical necessity is established, the physician will issue a detailed prescription for the orthotics, outlining specific device requirements and their intended medical purpose. Thorough medical records, including test results and clinical notes, are essential to support the claim for Medicare coverage. This documentation demonstrates the orthotics are essential for managing a diagnosed medical condition.

The next step involves working with a Medicare-enrolled supplier to obtain the prescribed orthotics. The supplier uses the physician’s prescription and supporting documentation to provide the appropriate shoes or inserts and ensure proper fitting. The supplier is responsible for submitting the claim directly to Medicare for payment. Beneficiaries should confirm with their supplier that they accept Medicare assignment to ensure they are only responsible for their deductible and coinsurance.