It is not uncommon for enrollees to seek treatment from a podiatrist for their feet, ankles and lower legs. Any Medicare beneficiary that deals with the pain of diabetes and suffers from neuropathy or any infection deserves the protection and ensured coverage for the given procedure and service. If recommended by a doctor or approved healthcare practitioner as medically necessary then Original Medicare recognizes this.
What Type of Foot Care is Covered Under Original Medicare?
Original Medicare Part B covers podiatry foot exams and treatment for those with diabetes-related neuropathy. It also covers medically necessary care and treatment for foot injuries or other conditions such as heel spurs, bunions, and hammertoe, for just three examples.
What Diabetic Foot Care is Covered by Original Medicare?
If you have a diagnosis of diabetic neuropathy, Medicare Part B will pay for:
- Nail care.
- Removal of calluses and corns.
- Specialized shoes and inserts if recommended by your podiatrist.
If you are hospitalized and need special medically necessary foot care. Medicare Part A will click in and cover the needed care the same as any in-patient medical care is provided.
Unfortunately, you must have been receiving foot care for your diabetic neuropathy for six months before Medicare will begin paying for it.
How Often Does Medicare Pay for Diabetic Foot Care?
If you have a diagnosis of diabetic neuropathy, Original Medicare will pay for you to have a foot evaluation every six months.
If special shoes are recommended by your podiatrist, Medicare will pay for the following:
- One pair of custom-molded shoes per year including the appointments you need for fitting.
- If you prefer custom-molded inserts instead of custom-molded shoes, Medicare will pay for two inserts a year.
- You can have three extra-depth inserts a year instead of custom-molded shoes.
What Podiatry Services Does Medicare Cover Unrelated to Diabetic Foot Care?
Medicare covers foot care for injuries, emergencies, and other medical conditions. Some examples of medical conditions of the feet that may be covered under Original Medicare if a Medicare-approved provider prescribes medically necessary care are:
- Infected toenails
- Heel spurs
- Bunions. You will be covered for medically necessary treatment such as toe spacers, pads, bunion inserts, or surgery.
- Hammertoes. These can be very painful and if your healthcare provider determines surgery is medically necessary, Medicare will cover the surgery. You will still pay your coinsurance and deductible.
- Plantar warts
- Plantar fasciitis
- Fungal nails with pain or a secondary infection.
Does Medicare Cover Orthotics?
Orthotics are artificial devices like splints and braces. They are considered durable medical equipment and covered under Original Medicare Part B. Some examples of orthotics that are covered include:
- Braces for feet and ankles.
- Orthotics for plantar fasciitis.
What foot Care Services Are Not Covered by Original Medicare?
Medicare does not cover routine foot care unless an approved Medicare provider orders these services as medically necessary. Those routine services include:
- Nail trimming. There are exceptions. If you are unable to clip your own nails and your doctor determines it is medically necessary, Medicare will pay for your nail trimming.
- Treatment for routine calluses.
- Application of lotions to your feet and legs.
- Treatment for flat foot.
- Fitting for orthopedic shoes.
- Removal of dead skin.
What Are the Costs of Medically Necessary Foot Care?
The out-of-pocket cost of your medically necessary foot care depends on several factors:
- How much the doctor charges and whether he or she accepts Medicare assignment.
- Where you receive your care. Will it be in the doctor’s office or the hospital? After you meet your Part B deductible, you will pay 20% of the Medicare Approved amount for services provided in your doctor’s office. You will also have a co-payment for outpatient hospital treatment.
- Whether the doctor recommends you get services more often than Medicare will pay for them.
Do Medicare Supplemental Insurance (Medigap Plans) Cover Foot Care?
Medicare supplemental insurance plans do not cover foot care that is not covered by Original Medicare. The Medigap plan you have may assist with your out-of-pocket costs by paying some of the coinsurance or deductible and other out-of-pocket expenses you have available to you from your Part B coverage. Check your plan carefully to determine coverage.
Do Medicare Advantage Plans Cover Foot Care?
Each Medicare Advantage Plan is different. Some cover foot care, and it will depend on your co-pays, co-insurance, and deductible. If your plan covers foot care above that which is provided by Original Medicare, it should be clearly spelled out in your plan details.
Your Medicare Advantage Plan may require you to see a podiatrist or medical doctor who is in the Advantage Plan network to have coverage for your foot care.
- Foot Care Coverage, Medicare.
- 2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts, CMS.