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. Medicare 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:
- Any existing insurance you may have
- How much your doctor decides to charge
- If your doctor accepts Medicare
- The type of facility you’re visiting
- 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
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.
How frequently will Medicare pay for new diabetic shoes due to wear and tear?
Medicare will cover one pair of custom molded diabetic shoes per calendar year.
If the shoes have been ordered and the patient is unable to pick up due to lack of transportation or care, can the provider take the shoes to the patient home and bill for them?
Ivonne, this is something you would need to speak about with your physician directly as each provider has different policies regarding patient care.
Since Oct 2021, many places I called in the Phoenix AZ area have stopped providing diabetic shoes or limit it to just one or two of their many regional locations. Is there a reason for this that is related to medicare changes or insurance/law policy changes? (Just checking before I assume it’s fallout from the covid-related shrinkage of available empoyees.) Thank you.
Hi – there could be a number of reasons a retail location would not have a larger selection of diabetic shoes. The newest requirements for medical necessity for diabetic shoes went into effect in November 2020, so this could be a supplier issue.
1 year from date of delivery. Medicare stopped allowing “Calendar year because people would get shoes and inserts delivered in December and then again in January. After this abuse was discovered, they reverted back to date of service.
Any update on this coverage for 2022?
Please explain Medicare therapeutic shoe policy for people with neuropathy and other qualifying findings but caused by a disease other than diabetes
Hi Alan! As of now, Medicare will only cover therapeutic shoes if the Medicare beneficiary has diabetes as well as meets these additional requirements.
Hello. I have severe nerve damage in my right foot but I’m not diabetic. The only shoes I can wear cost $160. I’m on disability and I’m in debt from buying them on my credit card. Will medicare consider other diagnoses?
Hi Yvette. At this time, Medicare will only cover them if you’re a diabetic. I would reach out to your healthcare provider directly to see if they have any other options for you.
Wouldn’t this qualify for filing a complaint with Medicare or health insurance and requesting a formal review so it can be considered as an authorized exception for coverage?
Are diabetic shoes covered if ordered by a nurse practioner?
Hi Diane! As long as the NP meets certain conditions, they will be covered.
I’m looking for a. Place to get my diabetic shoes. I’ll need to be fitted.
Hi Barbara! You can use Medicare.gov online search tool for medical equipment and supplies to find a supplier near you.
I have type 2 diabetes,my PvP sent me to a podiatrist because of diabetic neuropathy, the podiatrist confirmed the neuropathy and said I have developed hammer goes and need diabetic shoes that Medicare would pay for them and some replacement insoles ,now what do I do?
Hi Samantha! Your doctor should be able to help you find a diabetic shoe manufacturer that accepts Medicare who can help you get the shoes you need.
I have to have custom diabetic shoes because of a deformed foot. I have all the necessary forms filled out by the right doctors that I need. The place that is making my new shoes says medicare will pay 80% of the cost. My supplemental insurance will pay the other 20%. Now I am told that medicare pays only a certain dollar amount and stops even though it doesn’t meet the 80% leaving my bill at $380. Is this the right information or is the company making my shoes not filing the right papers through medicare?
Hi Monty! Without seeing the itemized bill, it’s very difficult to say if it’s accurate or if the diabetic shoe company is billing incorrectly. The $380 could be a combination of many things, including the Part B deductible. Are you sure you have a Medigap plan vs Medicare Advantage? That could also be the issue here. I would call Medicare directly to find out for sure where these charges are coming from.
I was wondering how often is a person able to have the diabetic shoes covered by Medicaid?
Hi Frank! I believe the benefit is limited to one pair of shoes and up to 3 pairs of inserts or shoe modifications per calendar year.
What is considered a calendar year? 1 year from the date they were dispensed? A fiscal calendar year? Or January through December?
Hi Cristina! A calendar year runs from January 1st-December 31st.
I’m in a situation my Prostedics are in need of replacement have had them for year my problem my healthcare system is in Rancho Cucamonga Ca. Coverage area is not in Kern County were I at and they don’t cover any of my Amputee needs never have. Reason I have open Ulcers on left stump. I am responsible for what Medicare does not pay. Not eligible for welfare or Medical and permanently on federal disability. Can I use Medicare to pay for housing and education?
Hi Aaron! It sounds like you have a Medicare Advantage plan vs a Medicare Supplement plan. A Medicare Advantage plan provides less coverage than a Medigap plan would, especially in situations such as yours. If a Medigap plan does not fit into your budget, you may be eligible for a Medicare Savings Program. You may also be eligible for the Extra Help Program. Both of these programs will help you pay for the out of pocket costs that Medicare doesn’t cover.
Great web site recomend this site for everyone with medicare
Thank you Gloria! We really appreciate that!