Your Medicare Coverage
Is my test, item, or service covered?
Therapeutic shoes or inserts
How often is it covered?
Medicare Part B (Medical Insurance) covers the furnishing and fitting of either of these each calendar year:
- One pair of custom-molded shoes and inserts
- One pair of extra-depth shoes
Medicare also covers:
- 2 additional pairs of inserts each calendar year for custom-molded shoes
- 3 pairs of inserts each calendar year for extra-depth shoes.
Medicare will cover shoe modifications instead of inserts.
All people with Part B who have diabetes and severe diabetic foot disease are covered. Your doctor must certify that you need therapeutic shoes or inserts. A podiatrist or other qualified doctor must prescribe these items and they must be provided by one these:
- A podiatrist
- An orthotist
- A prosthetist
- A pedorthist
- Other qualified individual
Your costs in Original Medicare
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 if they participate in Medicare before you get therapeutic shoes. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren't "participating," they may choose not to accept assignment. If suppliers don't accept assignment, there's no limit on the amount they can charge you.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- Whether your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.