How Much Does Medicare Pay for Diabetic Shoes?

For individuals with diabetes, proper foot care is an important aspect of managing the condition and preventing severe complications. Specialized footwear, often referred to as therapeutic shoes, can help protect the feet and reduce risks of diabetic foot disease. This article explains Medicare’s coverage for these items, outlining eligibility and the process for obtaining them.

Medicare’s Coverage for Diabetic Footwear

Medicare Part B provides coverage for therapeutic footwear for individuals with diabetes. This coverage includes specialized shoes and custom inserts. Therapeutic shoes are crafted to reduce pressure points, accommodate foot deformities, and prevent skin breakdown, which can lead to ulcers and infections.

These covered items fall into two categories: extra-depth shoes and custom-molded shoes. Extra-depth shoes offer additional room to accommodate inserts and reduce friction. Custom-molded shoes are made from a model of the patient’s foot, providing a precise fit for complex deformities. Medicare also covers inserts, which are total contact, multi-density removable inlays designed to distribute pressure evenly across the foot. These inserts are important for cushioning and supporting the foot to prevent serious foot complications.

Eligibility for Diabetic Shoe Coverage

To qualify for Medicare coverage, individuals must be enrolled in Medicare Part B and have a documented diagnosis of diabetes. Medicare requires specific foot conditions related to diabetes to establish medical necessity.

Qualifying foot conditions include:
A history of partial or complete foot amputation
Previous foot ulceration
Pre-ulcerative calluses
Peripheral neuropathy with evidence of callus formation
A foot deformity
Poor circulation in either foot

A physician managing the individual’s diabetes must certify the need for therapeutic footwear to prevent further foot complications.

The Process for Obtaining Covered Footwear

Obtaining Medicare-covered diabetic footwear begins with a medical evaluation. The individual’s treating physician must certify the medical necessity for therapeutic shoes and inserts. A podiatrist or other qualified doctor must also provide a prescription for the specific type of shoes and inserts needed.

After securing the necessary documentation, individuals must obtain their footwear from a Medicare-approved Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier. Verify the supplier is enrolled in Medicare and accepts assignment to ensure proper coverage and limit out-of-pocket expenses. Approved suppliers can be found through Medicare’s online directories or by asking their prescribing physician for recommendations. The supplier will perform a professional fitting to ensure the shoes and inserts properly accommodate the patient’s feet and provide therapeutic benefits.

Your Out-of-Pocket Costs for Diabetic Shoes

While Medicare Part B covers therapeutic diabetic shoes, beneficiaries are responsible for out-of-pocket costs. Before Medicare pays, the annual Part B deductible must be met. For 2025, this deductible is $257. After the deductible is met, Medicare covers 80% of the Medicare-approved amount for the shoes and inserts.

The beneficiary is responsible for the remaining 20% as coinsurance. Choose a supplier who accepts “assignment,” meaning they accept the Medicare-approved amount as full payment. This limits your financial responsibility to the deductible and coinsurance, preventing unexpected balance billing. Medicare allows one pair of therapeutic shoes and three pairs of inserts per calendar year, provided eligibility criteria are met. This annual benefit resets each January, requiring re-certification by the doctor to maintain coverage for new footwear.