Medical Billing Services

Medicare Coverage for Diabetics Shoes

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.

Many diabetics suffer from diabetic neuropathy, this nerve damage can make feet susceptible to injuries in a few different ways. 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

Coverage for Therapeutic Shoes and Inserts

Medicare Part B (Medical Insurance) covers the furnishing and fitting of either of these each calendar year if you have diabetes and severe diabetic foot disease:

  • 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.

Original Medicare

If you’re a Medicare Beneficiary with Parts A and B, with diabetes, and you have “Medically Necessary” reasons for needing diabetic shoes, you should be eligible. If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. 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 the assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept the assignment. If suppliers don’t accept assignment, there’s no limit on the amount they can charge you.

Medicare Advantage Plan

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 Part A covers. So, if you’re enrolled in a 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.

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 Part D Prescription Drug plan. Prescription Drug plans can help cover the costs of your daily diabetic prescriptions.

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.

Reference: 

Therapeutic shoes & inserts

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