Does Medicare Cover Shoe Orthotics?

There are several types of orthotics, including back braces, and most popularly, shoe orthotics. Shoe orthotics are custom-made shoe inserts that can relieve your foot pain and decrease the likelihood of further health complications related to your foot condition. Your Medicare doctor may decide you need to be prescribed these devices if you have foot pain or other types of foot related medical conditions. 

Shoe orthotics provide relief from pain and offer physical support for your feet. This can help with faster recovery or make life more comfortable and less painful for you. Shoe orthotics can be very helpful in maintaining an active lifestyle. Once your pain is decreased you may be able to move around freely and increase your overall health! 

Some of the underlying causes that doctors will look for when prescribing these orthotics are arthritis, bunions, bursitis, plantar fasciitis, tendinitis, arch or heel pain, or diabetic foot ulcers. 

Key Terms to Know

Before we begin to answer the question of whether or not Medicare will cover shoe orthotics, here are some important terms and definitions we think you should know:

• Original Medicare is a fee-for-service health plan that has two parts: Part A, which is hospital insurance and Part B, which is medical insurance. After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share which are called coinsurance or copayment and deductibles. Original Medicare coverage is provided by Medicare directly and not a third party private, for-profit insurance company.
• Medicare Advantage (MA), is also sometimes called Part C. Medicare Advantage includes Part A, hospital insurance and Part B, medical insurance. This type of Medicare is provided by Private Insurance that is approved by Medicare.

Whether you chose to be covered under Original Medicare or Medicare Advantage, you can decide if you want prescription drug coverage and supplemental coverage. 

Understanding Medicare Coverage of Shoe Orthotics

Now, to answer the question of whether Medicare covers shoe orthotics: Original Medicare generally pays 80 percent of the Medicare-approved cost for shoe orthotics, therapeutic shoes, and shoe inserts after you have met your deductible; after that, you’ll only be responsible for the remaining 20 percent. 

If your Medicare doctor decides orthotics are medically necessary for you and prescribes them to you, Medicare Part B, medical insurance, may cover 80 percent of the approved costs as long as you buy the orthotics from a prescriber that participates in Medicare. 

To recap, you must meet the following two conditions:

• Your Medicare doctor has decided shoe orthotics are medically necessary for you.
• You purchase your shoe orthotics from a Medicare-participating supplier.

Now we will get a bit detailed with the terms of the benefits:

Shoe orthotics are categorized by Medicare as Durable Medical Equipment or DME. They may also be classified as Durable Medical Equipment Prosthetics, Orthotics, & Supplies or DMEPOS. Your shoe orthotics may fall under the DME or DMEPOS benefit which means Medicare will generally cover 80 percent of the approved costs. Again, this is only when your Medicare doctor has recommended them for you or prescribed them to you and only when you get the shoe orthotics from a Medicare-participating supplier. 

People with diabetes who suffer from severe diabetic foot disease can be prescribed inserts or therapeutic shoes from the Medicare doctor. In this situation, Medicare Part B may cover the isoles or therapeutic shoes if your Medicare doctor certifies that they are medically necessary for you as a person who suffers from severe diabetic foot disease. After your doctor has certified that this is medically necessary for you, you will also need to get your inserts or therapeutic shoes from a Medicare-participating supplier. 

Depending on your case, the orthotics you need for your foot related health issue can be premade or custom-made. The coverage of 80 percent by Medicare Part B, DME or DMEPOS benefit, is provided when the Medicare doctor decides the shoe orthotics are medically necessary for your recovery or necessarily to avoid further complications for your health. 

Shoe orthotics are medical equipment you can benefit from in or out of your home to maintain an active, healthy lifestyle. Mobility is an important part of your health! Shoe orthotics or similar medical equipment are usually made durable and built to last for over three years. 

If you think shoe orthotics may be necessary for your foot-related health issue, you should see your Medicare doctor. If your doctor decides that shoe orthotics are medically necessary for you, please ask your doctor as well as the shoe orthotic supplier if you meet the criteria for coverage. And please remember you will need to have paid your deductible under Medicare Part B. If you are eligible for the coverage, Medicare will pay 80 percent of the approved costs, and the remaining 20 percent will be your responsibility to pay. You may also talk to your Medicare doctor to ensure you have the right kind of Medicare coverage for your health needs.

>> Questions about your Medicare coverage? Contact Cano Health at 855.CANOMED (855.226.6633) to speak with a Benefit Coordinator.