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Medicare Coverage for Diabetic Shoes


Medicare can provide coverage for shoes and inserts designed for people with diabetes. Medicare beneficiaries will have help covering the cost of their diabetic supplies as well as reimbursement for diabetic shoes. We’ll discuss where you can buy your shoes, how much they cost, and more.

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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, we’ll 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:

  • Diabetes
  • Foot deformity
  • Nerve damage caused by diabetes
  • Foot ulcers
  • Amputation of the foot
  • Poor circulation
  • 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.

What Diabetic Shoes Will Medicare Cover?

Medicare allows one pair of extra-depth shoes and one pair of custom-molded shoes per calendar year. Also, Medicare covers up to five pairs of inserts each calendar year.

If the doctor or supplier submitting the claims for your diabetic shoes and/or inserts doesn’t accept Medicare, Medicare won’t pay the claims. You should always contact your supplier (physician, facility, or other practitioners) to make sure they participate in Medicare beforehand. If the supplier participates in Medicare, they accept Medicare assignment. Remember, if the supplier doesn’t accept Medicare, they control how much they can charge you.

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What is the Therapeutic Shoe Bill (TSB)?

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
  • Foot deformity
  • Poor blood circulation
  • History of ulcers
  • History of pre-ulcerative calluses
  • Diabetic neuropathy with evidence of callus formation

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

Where to Buy Medicare-Approved Diabetic Shoes

When you’re ready for a pair of diabetic shoes, you’ll have plenty of options. You can buy the shoes from your podiatrist or other medical supply carriers. Another option is finding a supplier online. Your diabetic shoes need to be both fitted by a podiatrist or other doctor. Whoever prescribes diabetic shoes can also supply the shoes. Before finalizing any purchases, be sure the supplier accepts Medicare.

How Much Do Diabetic Shoes Cost?

Diabetic shoes can be costly because they’re specialty shoes and need to be custom-fitted for your feet. On average, diabetic shoes can range in cost from $50-$200 per pair.

Your out-of-pocket costs may depend on several factors:

  1. Any existing insurance you may have
  2. How much your doctor decides to charge 
  3. If your doctor accepts Medicare
  4. The type of facility you’re visiting
  5. Where you receive your test, item, or service

Medicare Reimbursement for Shoes

For Medicare to reimburse for the cost of shoes, you’ll need to visit only doctors and suppliers that take Medicare. If you visit a doctor who doesn’t accept Medicare, you could end up footing the entire bill.

Do Medicare Advantage Plans Cover Diabetic Shoes?

Medicare Advantage policies can cover the costs of your therapeutic shoes. Since Medicare covers diabetic shoes, Medicare Advantage plans will also cover diabetic shoes.

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Of course, you must still meet all eligibility requirements. Keep in mind, Advantage plans have specific networks. If your plan’s network doesn’t include your doctor, you may not have coverage for your shoes or visits.

Can Medigap Help Cover the Cost of 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.

FAQs

Does Medicare cover shoes for diabetic neuropathy?
Medicare can cover extra-depth shoes for diabetic neuropathy. You can get one pair of extra-depth shoes, and three pairs of inserts.
Can nurse practitioners prescribe diabetic shoes?
Nurse practitioners can prescribe diabetic shoes. Physician assistants, nurse specialists, and podiatrists can also prescribe these shoes. Doctors need to provide proper documentation that the patient’s feet have a thorough examination.
Are diabetic shoes considered Durable Medical Equipment?
Diabetic shoes will fall under Part B benefits, much like most durable medical equipment.

How to Get Help with Medicare Coverage for Diabetic Shoes

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 won’t 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.

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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