There are several types of orthotics, including back braces, and most popularly, shoe orthotics. Shoe orthotics are custom-made shoe inserts that can relieve your foot pain and decrease the likelihood of further health complications related to your foot condition. Your Medicare doctor may decide you need to be prescribed these devices if you have foot pain or other types of foot related medical conditions.
Shoe orthotics provide relief from pain and offer physical support for your feet. This can help with faster recovery or make life more comfortable and less painful for you. Shoe orthotics can be very helpful in maintaining an active lifestyle. Once your pain is decreased you may be able to move around freely and increase your overall health!
Some of the underlying causes that doctors will look for when prescribing these orthotics are arthritis, bunions, bursitis, plantar fasciitis, tendinitis, arch or heel pain, or diabetic foot ulcers.
Key Terms to Know
Before we begin to answer the question of whether or not Medicare will cover shoe orthotics, here are some important terms and definitions we think you should know:
- Original Medicare is a fee-for-service health plan that has two parts: Part A, which is hospital insurance and Part B, which is medical insurance. After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share which are called coinsurance or copayment and deductibles. Original Medicare coverage is provided by Medicare directly and not a third party private, for-profit insurance company.
- Medicare Advantage (MA), is also sometimes called Part C. Medicare Advantage includes Part A, hospital insurance and Part B, medical insurance. This type of Medicare is provided by Private Insurance that is approved by Medicare.
Whether you chose to be covered under Original Medicare or Medicare Advantage, you can decide if you want prescription drug coverage and supplemental coverage.
Understanding Medicare Coverage of Shoe Orthotics
Now, to answer the question of whether Medicare covers shoe orthotics: Original Medicare generally pays 80 percent of the Medicare-approved cost for shoe orthotics, therapeutic shoes, and shoe inserts after you have met your deductible; after that, you’ll only be responsible for the remaining 20 percent.
If your Medicare doctor decides orthotics are medically necessary for you and prescribes them to you, Medicare Part B, medical insurance, may cover 80 percent of the approved costs as long as you buy the orthotics from a prescriber that participates in Medicare.
To recap, you must meet the following two conditions:
- Your Medicare doctor has decided shoe orthotics are medically necessary for you.
- You purchase your shoe orthotics from a Medicare-participating supplier.
Now we will get a bit detailed with the terms of the benefits:
Shoe orthotics are categorized by Medicare as Durable Medical Equipment or DME. They may also be classified as Durable Medical Equipment Prosthetics, Orthotics, & Supplies or DMEPOS. Your shoe orthotics may fall under the DME or DMEPOS benefit which means Medicare will generally cover 80 percent of the approved costs. Again, this is only when your Medicare doctor has recommended them for you or prescribed them to you and only when you get the shoe orthotics from a Medicare-participating supplier.
People with diabetes who suffer from severe diabetic foot disease can be prescribed inserts or therapeutic shoes from the Medicare doctor. In this situation, Medicare Part B may cover the isoles or therapeutic shoes if your Medicare doctor certifies that they are medically necessary for you as a person who suffers from severe diabetic foot disease. After your doctor has certified that this is medically necessary for you, you will also need to get your inserts or therapeutic shoes from a Medicare-participating supplier.
Depending on your case, the orthotics you need for your foot related health issue can be premade or custom-made. The coverage of 80 percent by Medicare Part B, DME or DMEPOS benefit, is provided when the Medicare doctor decides the shoe orthotics are medically necessary for your recovery or necessarily to avoid further complications for your health.
Shoe orthotics are medical equipment you can benefit from in or out of your home to maintain an active, healthy lifestyle. Mobility is an important part of your health! Shoe orthotics or similar medical equipment are usually made durable and built to last for over three years.
If you think shoe orthotics may be necessary for your foot-related health issue, you should see your Medicare doctor. If your doctor decides that shoe orthotics are medically necessary for you, please ask your doctor as well as the shoe orthotic supplier if you meet the criteria for coverage. And please remember you will need to have paid your deductible under Medicare Part B. If you are eligible for the coverage, Medicare will pay 80 percent of the approved costs, and the remaining 20 percent will be your responsibility to pay. You may also talk to your Medicare doctor to ensure you have the right kind of Medicare coverage for your health needs.
>> Questions about your Medicare coverage? Contact Cano Health at 855.CANOMED (855.226.6633) to speak with a Benefit Coordinator.
FAQs
Shoe orthotics are categorized by Medicare as Durable Medical Equipment or DME. They may also be classified as Durable Medical Equipment Prosthetics, Orthotics, & Supplies or DMEPOS. Your shoe orthotics may fall under the DME or DMEPOS benefit which means Medicare will generally cover 80 percent of the approved costs.
Will Medicare pay for shoe orthotics? ›
In short, yes. Medicare covers orthotics shoes and inserts for specific conditions. Not everyone is eligible for Medicare to cover the cost of the orthotics – and in many cases, you may need to pay a small co-payment (20%).
What's the average price for foot orthotics? ›
Custom orthotics are specially molded to match the exact shape of your feet to treat specific foot problems. They provide firm, long-lasting support and are more effective for issues like plantar fasciitis or arthritis. However, they can be expensive, typically ranging from $200 to $800.
How do I get orthotics covered? ›
How do I submit a claim for orthotics?
- Recommendation or referral, from a licensed physician, podiatrist or chiropodist, must include the medical condition requiring the use of orthotic appliances.
- Copies of the biomechanical examination and gait analysis performed.
Orthotics refers to custom-made shoe inserts prescribed by a licensed doctor of podiatric medicine, an osteopathic doctor, or a medical doctor after a medical examination and diagnosis. Orthotics are designed to accommodate or correct an abnormal or irregular walking pattern.
Do you need a prescription for orthotic shoes? ›
Things to know
A podiatrist (foot doctor) or other qualified doctor must prescribe the shoes or inserts, and you must get the shoes or inserts from one of these: A podiatrist. An orthotist. A prosthetist.
How to bill for orthotics for Medicare? ›
Supplies can be billed with 97760 and 97761 if an orthotic is fabricated. 97763 should be used for all subsequent encounters for modifications, fitting adjustments, and additional training regardless of whether the orthotic is custom-made or prefabricated. Remember, these are time-based codes.
How do you get orthotics for shoes? ›
A podiatrist will prescribe orthotics based on medical problems or pain a patient may be experiencing. The podiatrist will also watch how a patient moves (known as gait analysis) and consider other issues like their level and type of activity, foot type, and the movement of their ankle, knee and hip.
Are orthotics usually covered by insurance? ›
Generally, orthotics are covered if:
The orthotics are prescribed by a qualified medical practitioner for protection, support, pain relief, and body alignment. The insurance contract specifically covers orthotics. They are made from the appropriate material, which is often pre-specified in your plan.
What are the side effects of wearing orthotics? ›
Orthotics can sometimes rub against the skin, causing blisters or irritation. This is more likely to occur if your orthotics are not fitted properly or if you wear shoes that are too tight.
The Basics ---
Unless you have a complex foot disorder, are diabetic, are a high- performance athlete, or have a recurring injury that over-the-counter insoles can't address, you likely don't need custom orthotics.
Do over the counter orthotics work? ›
OTC inserts are usually made of materials like foam or gel, and they last for about a year or so. While these orthotics provide support, they don't correct actual problems that are plaguing your feet. Custom orthotics, on the other hand, are specialized to your feet.
How do I get a prescription for custom orthotics? ›
Your health care professional will conduct a medical history assessment, a biomechanical examination, a gait analysis, and finally an orthotic evaluation – all of which are necessary for the orthotics provider to perform the task of building a custom orthotic especially for you.
Are foot orthotics tax deductible? ›
If the inserts were medically necessary to maintain your health, you can deduct them as an itemized medical expense on Schedule A. Medical, dental, and vision expenses are reported on Schedule A and entered in the Deductions & Credits section.
How to get orthotics covered by Medicare? ›
Your healthcare and the orthotic supplier must participate in the Medicare program for your orthotics to be covered. You will have to pay 20% of the cost of the orthotics after you've met your annual Medicare Part B deductible. Medicare will cover the remaining 80%.
What are the three types of orthotics? ›
There are three common types of orthotics known as soft, rigid, and semi-rigid. Soft orthotics are made to provide extra cushioning while the foot is planted on the ground. Semi-rigid orthotics, which are often used on flat feet, are designed to provide both cushioning and stability.
Does Medicare cover orthotics from the Good feet store? ›
Medicare Part B pays for 80 percent of the approved cost of either custom-made or pre-made orthotic devices. Of course, this is only possible if your health care provider feels it is medically necessary. Medicare categorizes orthotics under the durable medical equipment (DME) benefit.
Why are foot orthotics so expensive? ›
The Importance of Custom-Made Orthotics. One of the main reasons why orthotics are expensive is because they are custom-made to fit the unique shape and structure of an individual's feet.
Is there an alternative to orthotics? ›
Semi-custom Insoles. Semi-custom insoles offer the best of both worlds to people looking for relief from foot pain. Offering more individualized features than the generic, over-the-counter inserts you'll find at the drugstore or Walmart, semi-custom insoles are also significantly less expensive than custom orthotics.
Are prescription orthotics worth it? ›
Orthotics are invaluable to overweight people because they can help reduce the impact on the ligaments of their lower bodies. It can help to reduce pain. Custom orthotics can help those with arthritis, diabetes, and chronic pain by improving gait and reducing muscle and ligament strain.
Soft or 'accommodative' orthotics – Made out of soft compression material, soft orthotics provide extra cushion to ease pressure and soreness. These are ideal for conditions like diabetic foot ulcers and plantar fasciitis.
What shoes are considered orthotics? ›
Orthopaedic shoes are shoes that are specifically designed to support or accommodate the mechanics and structure of the foot, ankle and leg and they have a number of medically beneficial features and functions that separate them from regular shoes.
