Medicare covers orthotic shoes and inserts for specific conditions.
These are covered under Medicare Part B.
Medicare pays the bulk of the cost, but you may have to pay a portion yourself.
Medicare pays for a variety of medical devices and medical equipment, including orthotic shoes and inserts. While orthotics are not considered Durable Medical Equipment (DME), Medicare Part B still helps beneficiaries cover the cost. Find out what is covered and how much you will have to pay below.
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Medicare pays for orthotic shoes and inserts if you have severe foot disease or diabetes, and your doctor orders them. In many cases, Medicare’s durable medical equipment (DME) program covers equipment you use at home. While custom shoes and inserts are covered by Medicare Part B, they are not considered DME.
If your doctor orders custom orthotic shoes or inserts for an approved condition, your Medicare Part B plan will cover the following each year:
- One pair of custom-molded shoes
- One pair of custom-molded inserts
- One pair of extra-depth shoes
- Two pairs of additional inserts for custom-molded shoes
- Three pairs of additional inserts for extra-depth shoes
- Modifications for custom shoes instead of inserts
Custom-molded shoes and inserts can cost hundreds of dollars per pair. While this might seem a lot more expensive than over-the-counter manufactured options, the cost isn’t that much different when you factor in Medicare or insurance coverage. A custom pair of orthotic shoes can cost between $400 and $600. Medicare beneficiaries will pay 20% of the cost after meeting their annual deductible, and Medicare will pay 80%. This means that for a $600 orthotic, you would pay $120, while Medicare pays $480, if you have already satisfied your Part B deductible.
Do I need a prescription for custom orthotics?
You do need a prescription for custom orthotics if you want Medicare to help cover the cost. This prescription can be written by a physician or, in many cases, a nurse practitioner.
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Medicare Part B covers foot examinations and treatments from a doctor or specialized podiatrist if you have certain medical conditions like:
- Diabetes-related nerve damage
- Hammer toe
- Foot diseases
- Bunion deformities
- Heel spurs
- Other foot injuries or diseases
If you’re living with metabolic, neurologic or peripheral vascular disease, you may need more intensive foot care. These conditions can restrict blood circulation and cause you to lose feeling in your legs and feet. When this happens, even everyday tasks like clipping your toenails or removing calluses can be hazardous. While this type of routine care would otherwise be excluded from coverage, Medicare may help cover these types of services if you’re living with one of these vascular issues.
Medicare coverage for foot care isn’t exclusive to vascular disease, so talk to your doctor if you’re experiencing trouble with routine foot health. Medicare may extend coverage for these services if you’re living with other conditions that can include:
- Arteriosclerosis obliterans (ASO)
- Buerger’s disease
- Pernicious anemia
Custom foot orthotics are covered by Medicare Part B if ordered for you by a physician or nurse practitioner for a specific medical condition. Your healthcare and the orthotic supplier must participate in the Medicare program for your orthotics to be covered. You will have to pay 20% of the cost of the orthotics after you’ve met your annual Medicare Part B deductible. Medicare will cover the remaining 80%.
When should you stop wearing orthotics?
If your healthcare provider has recommended medication or treatment for you, you should always discuss your concerns with them before stopping. This even applies to orthotics. You may only require orthotics for a certain period to correct a problem, or it could be something you need permanently. If your orthotic becomes uncomfortable or doesn’t seem to be doing much to help you, talk to the provider who fitted you for the orthotic. You may require adjustments or a new device altogether.
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