Diabetes is a common disease that occurs when your blood sugar is too high. Type one diabetes is when the pancreas doesn’t make enough insulin, causing blood glucose levels to rise. Type two diabetes is when the body produces enough insulin, it just doesn’t use it properly.
One in 5 Americans over the age of 65 years have been diagnosed with type 1 or type 2 diabetes. Although, Medicare beneficiaries will have help covering the cost of their diabetic supplies. Being a Medicare beneficiary can also mean you may be eligible for a reimbursement on diabetic shoes.
Medicare Coverage for Diabetic Shoes
If you have Traditional Medicare, you should expect to pay any unmet Part B deductible and 20% coinsurance for diabetic testing supplies purchased through a local store that accepts Medicare assignment or from the National mail-order contract suppliers.
Those with a Medicare Part C Advantage Plan (such as an HMO or PPO), the plan you have will tell you which suppliers are in their network.
If you have a Part D Prescription Drug plan, you’ll have coverage on anti-diabetic drugs that help maintain blood sugar. With most Part D Prescription plans there is a coinsurance or copayment, there may also be a deductible that applies, this will depend on the plan you choose to enroll in that is available in your area
Diabetic Supplies Covered by Medicare
Durable Medical Equipment (DME) is covered under Medicare Part B medical, most diabetic supplies are considered DME supplies.
Medicare covers these self-testing supplies:
- Blood sugar monitors
- Test Strips
- Lancet devices and lancets
- Glucose control solutions.
If you use insulin, you might be able to get up to 300 test strips and 300 lancets every 3 months. If you don’t use insulin, you might be able to get 100 test strips and 100 lancets every 3 months.
Of course, if your doctor says it’s “Medically necessary” then Medicare will allow you to get additional test strips and lancets.
Diabetic Services Covered by Medicare
Generally, the Medicare beneficiary will be responsible for 20% of the Medicare-approved amount after the yearly Part B deductible.
If you have a Medicare Supplement plan, then you may pay little to no out of pocket costs on diabetic supplies. Talking with a licensed insurance agent in the state where you reside is the best way to find the most suitable plan for you.
- Diabetic screenings
- Glaucoma tests
- Foot exams and treatment
- Insulin and insulin pumps
- Medical Nutrition Therapy (MNT) services
- Welcome to Medicare preventive visit
- Yearly wellness exam
- Diabetic equipment and supplies
- Diabetes self-management training (DSMT)
- Therapeutic shoes or inserts
What is the Therapeutic Shoe Bill (TSB)
The TSB or diabetic shoe benefit was passed by Congress in May 1993. Ever since the bill was passed, Medicare Part B (Medical Insurance) provides reimbursement on therapeutic shoes, inserts, and modification for beneficiaries that have diabetes and meet specific eligibility requirements.
You might be eligible for diabetic shoes if you have Medicare Part B, diabetes, necessary documentation from a qualified physician, and you have at least one of the following:
- Amputation of all or part of either foot
- Foot deformity
- Poor blood circulation
- History of ulcers
- History of pre-ulcerative calluses
- Diabetic neuropathy with evidence of callus formation
If you think you’re unsure about your eligibility, you can contact a qualified expert or a Medicare representative.
What Will Medicare Cover?
Medicare allows one pair of extra-depth shoes per the calendar year, for qualified patients. Also, Medicare covers three pairs of inserts each calendar year.
Medicare covers diabetic shoes and inserts when the doctor opts into Medicare. If the doctor or supplier submitting the claims doesn’t accept Medicare, then Medicare won’t pay the claims. Doctors and suppliers must meet certain guidelines to enroll in Medicare.
Why are Diabetic Shoes Important?
Many diabetics suffer from diabetic neuropathy, this nerve damage can make feet susceptible to injuries in a few different ways, according to the Nation Institutes of Health:
- Injuries can take longer to heal when there is a restriction of blood flow
- Limbs can lose sensation, this makes it more difficult to detect an injury
- Some may lose feeling in their feet, and an unnoticed injury can lead to an infection
The Center for Disease Control (CDC) recommends quarterly foot exams for diabetics. In addition to regular exams, the agency recommends keeping feet clean, inspecting feet for injuries, keeping toenails carefully clipped, and wearing the right socks and shoes.
The National Institute of Health recommends talking with your doctor about special diabetic shoes and/ or shoe inserts. There are many cases where diabetics may need custom-made shoes that provide extra protection.
Studies have shown that prescription diabetic footwear can help prevent foot health complications that can happen because of diabetes. If you need diabetic shoes, a Podiatrist, Prosthetist, Orthotist, Pedorthic, or another type of professional needs to provide the prescription for therapeutic shoes
Advantage Coverage and Diabetic Shoes
If you have a Medicare Advantage plan, you have coverage from a private, Medicare-approved insurance company. These plans must cover everything that Original Medicare covers except for hospice care, which Medicare Part A covers.
So, if you’re enrolled in a Medicare Part C Advantage plan, you should have coverage on diabetic shoes if the eligibility conditions are met.
If you don’t have any additional coverage to Medicare, you may be eligible to enroll in a Medigap policy that can help pay for the out-of-pocket expenses associated with Medicare. A Medigap policy is the same thing as a Medicare Supplement.
Depending on the Medicare Supplement you choose to enroll in, you may have little to no out-of-pocket costs on your diabetic supplies. However, different letter plans pay for different amounts.
What Does This Mean for You?
If you’re a Medicare Beneficiary with Medicare Parts A and B, with diabetes, and you have “Medically Necessary” reasons for needing diabetic shoes, you should be eligible.
However, if you’re covered only through Traditional Medicare, the costs you’ll be responsible for will be: meeting your Part B deductible, and 20% coinsurance.
When you have additional coverage, such as a Medicare Supplement plan, you will reduce your expenses on diabetic supplies and services. If you’re a Medicare beneficiary, you should enroll in a Medicare Part D Prescription Drug plan. Prescription Drug plans can help cover the costs of your daily diabetic prescriptions.
Some beneficiaries may find the most benefit for them is in a Medicare Advantage plan. When you talk to one of our insurance agents licensed in your state, they can help you identify the best, most suitable plan for you. Or, you can fill out our online rate form to have rates sent to you via email.