Wednesday, April 10, 2024

Diabetic Shoes Covered By Insurance

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Does Medicare Cover Therapeutic Shoes

Are Diabetic Shoes Covered By Insurance?

Medicare will only cover your therapeutic shoes if your doctors and suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. It’s also important to ask your suppliers …

What Kind Of Shoes Do Diabetics Wear

Footwear Tips for Diabetes Patients Avoid shoes with pointed toes. Dont buy shoes with too flat a sole or high heels because they dont allow for even distribution of foot pressure. Look for styles that have soft insoles. Choose leather, canvas, or suede styles to allow adequate circulation of air.

What Are Diabetic Socks Do

Diabetic socks are specially designed to keep feet dry, decrease the risk of foot injury, and enhance blood circulation. They are a key part of foot care, which is an important aspect of diabetes management due to potential damage to the nervous and circulatory systems caused by high blood sugar levels.

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Patient Responsibility For Payment

Medicare will pay for 80% of the Medicare-approved amount either directly to the patient or by reimbursement after the Part B deductible is met. The patient is responsible for a minimum of 20% of the total payment amount and possibly more if the dispenser does not accept Medicare assignment and if the dispenser’s usual fee is higher than the payment amount.

Medicare pays only for therapeutic footwear from Medicare-approved suppliers, reimbursing 80% of the cost either to the patient or after the Part B deductible is met. The patient is responsible for the other 20% — or more if the supplier does not “accept assignment” from Medicare.

Show Sources Medicareâs Coverage of Diabetes Supplies & Services.

The National Institute of Diabetes and Digestive and Kidney Diseases of The National Institutes of Health. Publication: Feet Can Last a Lifetime: Medicare Coverage of Therapeutic Footwear for People with Diabetes. 1998.

How To Get Help With Medicare Coverage For Diabetic Shoes

Diabetic footwear  Southern Medical &  Adaptive Solutions

If you have diabetes and need therapeutic shoes, your doctor can help get you started. When you add Medigap coverage, you can be doubly assured your shoes wont break the bank.

Your Medigap plan can help with coinsurance, copays, and your Part B deductible. Our agents can help find the best options for you. Call us today for a quote in minutes! Or, if you prefer, you can complete an online rate form, and a member of our team will reach out to you.

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How To Keep Diabetic Feet Healthy

Even if youre wearing diabetic shoes, follow these tips to make sure your feet are healthy: 1 Check your feet every day to make sure there are no developing sores, ulcers, or calluses. 2 Trim your toenails regularly, making sure to cut straight across to prevent ingrown toenails. 3 Smooth your corns and calluses gently with a pumice stone or an exfoliating foot scrub. 4 Avoid using razors or other sharp tools on your feet. 5 Wash your feet daily with warm water to promote circulation.

How To Qualify For Medicare Diabetic Shoes

In order to qualify for Medicare covered diabetic shoes and diabetic insoles, a podiatrist must prescribe the items and the prescription must be filled by any of the specific health professionals as mentioned above. The prescribing doctor must complete a certificate of medical necessity for diabetic shoes and it must be documented in the patients medical records.

In order to qualify for the coverage of diabetic shoes, patients must be covered under Medicare Part B and meet all three of the following conditions:

1) Patient has diabetes

2) Patient has at least one of the following conditions:

  • Partial or complete foot amputation
  • Nerve damage in feet w/ signs of calluses on either foot
  • Foot deformities such as hammertoes or bunions
  • Poor circulation in the feet

3) Patients doctor certifies in writing stating that:

  • The aforementioned requirements are met for diabetic shoes
  • Patients certifying physcician is treating them for diabetes under a comprehensive plan of care
  • Specific reasons why patient needs diabetic shoes and/or inserts

Medicare does not offer coverage for diabetic shoes if all three of these requirements are not met.

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Does Medicare Pay For Diabetic Shoes

Original Medicare can pay a portion of the cost of your diabetic shoes. Part B will cover both the fitting and the footwear. The Part B deductible still applies.

Below, well look at just what you can get if Medicare pays for your diabetic shoes.

  • One custom pair of molded shoes with inserts if you have either a severe diabetic foot condition or diabetes
  • One pair of extra-depth shoes
  • Two extra pairs of inserts each calendar year for your custom-molded shoes
  • Three pairs of inserts each calendar year for extra-depth shoes

Also, Medicare can cover the cost of modifications to your shoes, rather than inserts. For Medicare to cover your diabetic shoe cost, your doctor must verify that the shoes are medically necessary.

You need to meet at least three of these health conditions:

  • Must be getting treatment through a thorough health care plan

Medicare also requires:

  • Verification of your need for therapeutic shoes and/or inserts from the doctor who treats your diabetes
  • Prescription for therapeutic shoes and/or inserts from a podiatrist or other qualified provider

Remember that even with Medicare, you may still pay a portion of the bill. You could end up with copays, coinsurance, and deductible costs.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

How To Get Your Diabetic Shoes Through Insurance

Diabetic shoes covered by Medicare

How to Get Your Diabetic Shoes Through Insurance HOW TO GET YOUR DIABETIC SHOES THROUGH YOUR INSURANCE: If you are diabetic and have Medicare and Medicaid, you could be eligible for a pair of shoes and 3 pairs of moldable insoles. It is that easy! All you have to do is bring in your insurance cards and a prescription from your doctor. We will contact your doctor for any additional information we need for billing. The process for getting shoes is very simple. First our diabetic shoe fitter will take a measurement of both feet for a personalized fit. Then you pick out the shoes you would like. After we place your order, your shoes will arrive in 7-10 days. If you are not diabetic, do not have Medicare, or your doctor does not approve you for these shoes, the price ranges from $115-$145 a pair. Our moldable insoles cost $50.00 per pair. However, we often run specials on our insoles and shoes. Please call us for our current specials. For more information about diabetic shoes call us atContinue reading > >

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Best For Neuropathy: Orthofeet Chattanooga Shoe


  • Includes fitting savers and anatomical insoles

  • Breathable mesh fabric

Peripheral neuropathy, the type of neuropathy commonly caused by diabetes, results from damage to nerves throughout the body, especially the hands and feet. Symptoms of neuropathy in the feet can include pain, a pins-and-needles sensation, numbness, and weakness.

Luckily, some diabetic shoes are particularly good at alleviating these symptoms, like these Mary Janes from OrthoFeet. The anatomical orthotic insoles and ergonomic soles provide excellent support and cushioning, and the round and wide toe box prevents uncomfortable pressure and leaves plenty of room for toe movement.

These casual shoes have a breathable fabric upper and soft padded interior that are kind to the skin and help prevent binding. The two-way straps also make it easy to achieve a comfortable fit, as well as slip the shoes on and off comfortably.

Arch Support: Yes | Materials: 100% leather, rubber sole | Close-Up: Two-way strap system

What Is The Therapeutic Shoe Bill

Congress passed the TSB or diabetic shoe benefit a while back. Ever since the bill was passed, Part B provides reimbursement for therapeutic shoes, inserts, and modifications for beneficiaries with diabetes who meet specific eligibility requirements.

You may be eligible if you have diabetes, documentation from a qualified physician, and at least one of the following:

  • Amputation of all or part of either foot
  • Diabetic neuropathy with evidence of callus formation

If youre unsure about your eligibility, you can contact a Medicare representative.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

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Why Trust Verywell Health

As a seasoned health writer, Alena Hall understands how important it is to know exactly what youre getting in a product intended for medical use. Over the years, she has reviewed dozens of products, from athletic recovery aids to condition-specific products to homeopathic essential oils, to help readers like you discover products that can help you live your best life.

Additional reporting to this story by Janae Price and Brittany Leitner

As a health writer, understands the importance of a knowledgeable and honest review. When there are so many different opinions out there, it’s great to have a concise answer that cuts through all the junk online. Every product in this piece has been thoroughly researched and sourced by professionals with potential user needs in mind.

As a health writer with over 8 years of experience, Brittany Leitner understands how important access to information is when it comes to making educated health decisions. She has interviewed dozens of medical experts, tested out hundreds of products, and aims to provide quality recommendations that won’t break the bank.

Medicare Coverage Of Therapeutic Footwear

Diabetic Shoes Covered By Insurance

Like with other durable medical equipment covered under Medicare Part B, diabetic shoes and inserts are generally covered for 80% of the cost. This leaves you to cover the remaining 20%. Covered diabetic shoes and inserts will also need to be purchased from a Medicare-approved provider. If you purchase shoes or inserts on your own from a non-approved footwear retailer, you will be responsible for 100% of the cost.

Although Medicare Part B is the primary coverage source for diabetic shoes and inserts, you might run into a situation in which custom shoes and inserts are required during a stay at a skilled nursing facility or hospital. If the shoes and inserts are provided by the facility, Medicare Part A may apply coverage instead of Part B. Medicare coverage provided under Part A is the inpatient benefit and covers the cost of services rendered while admitted to a medical facility for care.

Since Medicare Part D covers prescription drugs, it would not directly apply to coverage for diabetic shoes. Part D may apply if you are prescribed medications to treat diabetes in addition to the prescription of diabetic shoes and inserts.

TIP: Use the Medicare plan finder to find out if your existing plan covers podiatry services.

Also Check: How To Prevent Type 2 Diabetes

Orthopedic Shoes And Inserts Also Called Orthotics Can Be Used To Either Correct Foot Conditions Or To Relieve Symptoms Enough To Allow For Normal Mobility

They carry your weight around all day, every day, so its no surprise that many people experience issues with their feet even without an underlying medical issue. But throw in a condition that affects circulation, like diabetes, and foot problems are practically inevitable.

If you have diabetes, either your primary care doctor or your podiatrist may recommend treatment that includes either diabetic shoes or an orthotic insert. While these shoes and inserts can be expensive, they may be covered by Medicare for people with a diabetes diagnosis. Read on to learn more.

Does Medicare Cover The Cost Of Orthotics

Original Medicare insurance typically covers shoes for diabetics under Part B however, there are some restrictions. Medicare coverage recipients who require shoes for diabetic conditions will usually be able to receive one pair of custom-molded shoes and inserts and/or one pair of extra-depth shoes per calendar year.

Additionally, Medicare will cover two pairs of inserts for custom-molded shoes and three pairs of inserts for extra-depth shoes on top of the inserts that come with the original shoes. If you require new shoes or more inserts within the calendar year, you will likely have to cover the cost on your own.

TIP: Read our companion blog filled with tips on how to get Medicare to pay for diabetic shoes and inserts.

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Uniquely Trained And Certified

Here at OCFA, we offer the best quality Diabetic Shoes in Orange County! Our Physicians dispense Medicare covered Diabetic Shoesand Inserts from our offices. You will not need to go to any other facility and our Staff will take care of all of the required insurance paperwork. These shoes are wonderful for protecting your feet from sores or injuries.

We have over 1,000 shoes to choose from in every style. This includes shoes from: New Balance, SAS, Dr. Comfort, Brooks, Wolverine, Hush Puppies, Rockport and more!

Weve got a quaint showroom and display:

It really is that simple. Just call and make an appointment to be fitted for Diabetic Shoes and Inserts using your Medicare or PPO Insurance and we will take care of the rest.

Does Medicare Cover Shoes For Diabetics

Who should wear a diabetic shoe?

Foot injuries can happen to virtually anyone, and if you suffer from mobility issues, you may be more prone to foot injuries than others. However, there are also plenty of conditions like poor circulation, diabetes and congenital defects that can affect your feet and cause pain and difficulty getting around.

To address these concerns, you may require medications or even surgery, but many orthopedic problems can be treated first with custom shoes or inserts. This may have you wondering if Medicare covers the cost of diabetic shoes, insoles, or inserts.

TIP: Sign up for the Medicare Benefits newsletter and get more of your podiatry and footcare questions answered.

Medicare Benefits Solutions

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Plans That Do Not Exclude Foot Orthotics

Note: For plans that do not exclude coverage of foot orthotics, Aetna covers foot orthotics when the medical necessity criteria below are met. Please check benefit plan descriptions.

Foot orthotics are considered medically necessary for members who meet all of the following selection criteria:

  • Member has any of the following conditions:

  • Acute or chronic plantar fasciitis
  • Acute sport-related injuries
  • Calcaneal bursitis
  • Calcaneal spurs
  • Chronic ankle instability
  • Conditions related to diabetes
  • Inflammatory conditions
  • Medial osteoarthritis of the knee
  • Musculoskeletal/arthropathic deformities
  • Neurologically impaired feet
  • Vascular conditions , chronic thrombophlebitis)
  • Foot orthotics have no proven value for back pain, knee pain , pes planus , pronation, corns and calluses, hip osteoarthritis, and lower leg injuries

  • Musculoskeletal weakness
  • Structural deformities
  • Torsional conditions
  • The member must have symptoms associated with the particular foot condition and

  • The member has failed to respond to a course of appropriate conservative treatment . Orthotics should not be considered first line therapy.

  • Foot orthotics are considered experimental and investigational when these criteria are not met and for treatment of joint hypermobility syndrome.

    The following types of foot orthotics are considered medically necessary for the above listed indications:

    One of the following per member per calendar year is considered medically necessary:

    Are Diabetic Shoes Covered By Insurance

    If youve heard of sugar and love the sweet substance, then chances are youve also heard of a not so sweet condition that can accompany it.

    Its none other than diabetes, which currently impacts more than 34.2 million Americans. To give you a larger perspective on how pervasive it is, more than 1 in 10 people in the country have it. That number doesnt include the 88 million Americans who are at risk of prediabetes.

    Apart from it affecting your thirst and hunger among its list of symptoms, one of the most major ways it canimpact your lifestyle is in your feet. Because diabetes tends to damage your nerves, you might begin to lose some feeling in your two long limbs. This can lead to further complications when it comes to a reduced inability to heal or ward off an incoming infection.

    Even though you might have never predicted that the innocent looking white powder could have caused your feet to lose their senses, it doesnt mean that you should give up when it comes to treatment and healing.

    Thats where diabetic shoes can play a big therapeutic role in reducing the pressure that your feet have to tread with on a daily basis. They can additionally provide a cushion with ample support so that you can go about your life on your own two feet as usual.

    However, like all durable medical equipment , their benefits come attached with a hefty cost. What youll usually see for diabetic shoes is a range of $50-200 per pair.

    • Treatment must be done through a thorough health care plan.

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    Does Medicare Advantage Cover Diabetic Shoes

    If you have the Medicare Advantage plan, that means that you have coverage due to a private Medicare-approved insurance company. These plans should cover all that Original Medicare covers with an exception for hospice care, which is what Medicare Part A covers. Thus, if you are enrolled in a Medicare Part C Advantage plan you must have coverage on diabetic shoes if all of the eligibility conditions are met.

    Can Medigap Help Cover The Cost Of Diabetic Shoes

    Diabetic Shoes

    A Medigap policy may be just what you need to help cover your diabetic shoes. Medicare Supplement plans are a great asset in helping with extra costs. Because Medigap plans cover the balance of what Medicare does, Medicare Supplement policies can help cover the out-of-pocket expenses you may have when getting diabetic shoes.

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