Medicare coverage is available for many necessary podiatry related services and treatments. A podiatrist can help treat patients with Diabetes, Arthritis, and many other conditions that may cause issues with your feet, ankle, and leg. Below we’ll discuss the different podiatry treatments and options for coverage.
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What Podiatry Services are Covered by Medicare?
Medicare may cover some of the podiatry services that you need. You’ll have to meet the eligibility requirements to receive podiatry services.
You can visit with a podiatrist for foot conditions like a hammertoe, various injuries, heel spurs, and deformities. Podiatry services can include many types of treatments.
How Often Does Medicare Pay for Diabetic Foot Care?
Medicare Part B will cover podiatry for the treatment of nerve damage due to diabetes. Further, Medicare will pay for diabetic foot care every six months.
A prime example of diabetic foot care is diabetic peripheral neuropathy. But this only applies if you haven’t seen another foot care physician between your visits. Medicare Part B can also help pay for diabetic shoes.
Does Medicare Cover Orthotics?
Yes, orthotics are durable medical equipment that’s covered under Part B.
Some of the orthotics that Medicare may cover can include:
- Prosthetic devices
- Bracing for ankles, feet, knees, elbow, wrist, hand spine, neck, and back
Those with a Medicare Supplement plan have coverage to help pay for costs Medicare doesn’t; such as the coinsurance or applicable deductibles.
Does Medicare Cover Orthotics for Plantar Fasciitis?
Yes, as long as you met the eligibility requirements, your doctor can give you a prescription for treatment. Plantar Fasciitis is a severe breakdown of the soft tissue around your heel. This can be extremely painful and make it difficult to walk.
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Plantar Fasciitis is also known as Policeman’s Heel. Since this would fall under Medicare Part B, you would be responsible for 20% of the cost unless you have a Medigap plan. If you have a Medicare Advantage plan, they might cover it, but you could have higher cost-sharing than just the coinsurance.
Does Medicare Cover Bunion Surgery?
Medicare can cover bunion removal if your doctor finds it medically necessary and prescribes treatment. Your doctor may provide you a prescription for bunion inserts, pads, or toe spacers before they say surgery is medically necessary. Bunion removal can cost anywhere from $3,500 – $12,000. Without a supplement plan, you’ll be responsible for the coinsurance.
Does Medicare Cover Hammertoe Surgery?
Medicare will generally cover Hammertoe surgical procedures. But your doctor must decide that it’s necessary for your health. Hammertoe can cause severe pain and can affect the health of your foot.
If you have significant pain or balance issues, you may qualify for hammertoe surgery. On average, hammertoe surgery costs over $9,000 without insurance.
Does Medicare Cover Treatment for Ingrown Toenails?
Medicare will cover treatments for treatment for an ingrown toenail as long as your doctor deems it medically necessary. A podiatrist will remove the section of your toenail that has become ingrown and is causing you pain.
They may prescribe you antibiotics to treat any underlying infection. The prescription would not be covered under Medicare Part B, but it may be covered under a Medicare Part D Prescription Drug plan.
Does Medicare Cover Podiatry for Toenail Fungus?
Medicare will cover treatment for fungus within your toenail. Another term for this treatment is nail debridement. To be eligible, you must have severe, debilitating pain.
Evidence of several infections caused by the fungus may also qualify you. Nail debridement can take place in your doctors’ office and will fall under Part B.
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Podiatry Not Covered by Medicare
A variety of treatments aren’t “medically necessary.” When a service isn’t necessary to your health, Medicare won’t cover it. Unfortunately, routine foot care is something Medicare won’t consider essential.
Routine foot care that’s not covered by Medicare includes:
- Nail trimming
- Cleaning and soaking of the feet
- Corn and callus removal
- Preventative maintenance
- Flat foot treatment
Do Medicare Advantage Plans Cover Podiatry?
Medicare Advantage plans are different in each county. While they all have similarities, the actual coverage will vary.
Advantage plans must cover at least as good as Medicare. But, you’ll need to make sure a Podiatrist is in-network.
If you use a Podiatrist out of network, you’ll pay the entire bill. Although some Medicare Advantage PPO plans allow you to use out-of-network doctors, you just have to pay more for the same treatment. You’ll also be required to get a referral from your doctor to see a podiatrist specialist. With a Medigap plan, you don’t need referrals to see a specialist.
Do Medicare Supplement Plans Cover Podiatry
Medicare Supplement Plans (Medigap) allow you to see any doctor in the U.S. that accepts Medicare. Further, Medigap plans help you save money by paying the portion of the bill Medicare leaves you to pay. If your Medicare Part B benefits cover any services performed by a podiatrist specialist, your Medigap plan will also cover it.
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My wife has genetically progressive deformities of hammertoes, Morton’s Neuroma, and bunions that have limited her ability to walk for 10 minutes. A surgeon agreed operate on both feet for $20,000.00. However he doesn’t send in Medicare info. Can we do that ourselves and what do we need.
Sidney, you will need to confirm that the doctor accepts Medicare assignment. If the doctor does not accept Medicare, your wife will be responsible for 100% of the costs.
hello,
I am a non-diabetic 18 yr old , and both of my big toes have an ingrown toenail on one side, I’ve consulted with my doctor multiple times. Will Medicare cover the cost (fully or partially) of both toes? as I am going to move for university soon and am in need for the recovery to happen as soon as possible as it is definitely going to get worse over the moving period.
Hello! As long as the procedure is dedemed medically necessary, Medicare will cover up to 80% of the procedure.
I am a diabetic and foot doctors are very important for diabetics. I have an ingrown toe nail on both feet and if they get infected I could have the toe removed. I would rather have the toenail removed rather than the toe removed. Does Medicare cover that procedure?
Hi Nancy! If your doctor says the toenail removal is medically necessary, then Medicare will cover it. Your best option is to contact Medicare directly while you are with your doctor to see what documentation they would require.