Medicare Therapeutic Shoe Bill. What Is Your Diabetic Shoe Benefit?

 

If you have diabetes, Medicare or your insurance company may pay for shoes or sneakers at no out of pocket cost to you.* Medicare has specific coverage guidelines regarding what shoes it will cover and for what conditions. In general, if a beneficiary has Medicare Part B, has diabetes, and meets the specific conditions outlined below, Medicare will cover one pair of therapeutic shoes per calendar year, as long as the qualifying conditions continue to be met.

 

The types of shoes Medicare covers on a yearly basis include one of the following:

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• One pair of depth-inlay shoes and 3 pairs of inserts; or

• One pair of custom-molded shoes (including inserts) if a beneficiary can't wear depth-inlay shoes because of a foot deformity, and 2 additional pairs of inserts.

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In order for Medicare to pay for a beneficiary's therapeutic shoes, the doctor treating his/her diabetes must certify that the beneficiary: Has diabetes and that:

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• A podiatrist or other qualified doctor prescribes the shoes, and

• A doctor or other qualified individual like a pedorthist, orthotist, or prosthetist fits and provides the shoes.

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Has at least one of the following conditions in one or both feet:

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• Partial or complete foot amputation

• Past foot ulcers

• Calluses that could lead to foot ulcers

• damage caused by diabetes with evidence of callus formation

• Poor circulation

• Deformed foot (feet)

• Is being treated under a comprehensive diabetes care plan and needs therapeutic shoes and/or inserts because of diabetes.