Medicare's coverage of orthotics for plantar fasciitis depends on the type of device and whether your doctor prescribes it as medically necessary

Medicare Part B covers custom-made orthotics (shoe inserts molded to your foot) for plantar fasciitis if your doctor prescribes them and they meet specific requirements. The device must be made by a licensed orthotist, ordered by your physician, and documented as medically necessary for your condition. Medicare will not cover off-the-shelf inserts, arch supports you buy at a drugstore, or orthotics prescribed by a podiatrist unless that podiatrist is working under a physician's supervision in certain settings.

Coverage also requires that you have tried other treatments first — typically rest, stretching, anti-inflammatory medication, or physical therapy — before your doctor prescribes an orthotic device. Your doctor must document that these initial treatments did not relieve your pain. If these conditions are met, Medicare typically covers 80% of the approved amount after you meet your Part B deductible, and you pay the remaining 20%.

Key Takeaways

  • Medicare Part B covers custom orthotics for plantar fasciitis only when prescribed by a physician and made by a licensed orthotist, not over-the-counter inserts.
  • Your doctor must document that you tried conservative treatments (rest, stretching, physical therapy) before prescribing an orthotic device.
  • You pay 20% of the Medicare-approved cost after meeting your Part B deductible; the exact out-of-pocket amount depends on your plan and the device cost.
  • Podiatrists can prescribe orthotics that Medicare covers only in certain clinical settings where they work under physician supervision.
  • The prescription must come from your primary care doctor or a specialist, and the orthotic must be fabricated specifically for your foot, not a pre-made model.

How to get a Medicare-covered orthotic for plantar fasciitis

Start by seeing your primary care doctor or a rheumatologist, orthopedist, or physiatrist (a doctor who specializes in physical medicine). Describe your plantar fasciitis pain and any treatments you have already tried. Your doctor will examine your foot and may order imaging if needed. If conservative care has not worked, your doctor can write a prescription for a custom orthotic device.

Once you have the prescription, your doctor will refer you to a licensed orthotist — not a shoe store or online retailer. The orthotist will take a mold or scan of your foot and create a custom device fitted to your specific foot shape. This is the step that makes the device may be able to access for Medicare coverage. Before the orthotist begins work, confirm with them that they accept Medicare and understand the coverage rules, because not all orthotists do.

After the device is made, the orthotist will submit the claim to Medicare on your behalf. You will receive a notice showing what Medicare approved and what you owe. Keep all documentation — the prescription, the orthotist's invoice, and the Medicare notice — in case you need to appeal or have questions about your bill.

What Medicare does not cover

Medicare does not cover over-the-counter orthotics, even if they are recommended by your doctor. This includes gel inserts, arch supports, heel cups, and prefabricated insoles sold at drugstores, sporting goods stores, or online retailers. The device must be custom-made for your foot to may have access to.

Medicare also does not cover orthotics prescribed by a podiatrist in most cases, because podiatrists are not considered physicians under Medicare rules. The exception is when a podiatrist works in a hospital outpatient department or federally may have access to health center and the prescription is co-signed by a physician. If your podiatrist wants to prescribe an orthotic, ask them whether they work in a setting where Medicare will cover it.

Replacement orthotics are covered only once every five years, unless your foot structure changes significantly due to injury or disease. If your current orthotic breaks or wears out before five years have passed, you will likely pay out of pocket for a replacement.

What you will pay out of pocket

Your out-of-pocket cost depends on three things: whether you have met your Part B deductible for the year, the total cost of the custom orthotic, and the Medicare-approved amount for that device in your area.

If you have not met your Part B deductible (which is $226 in 2024, though this amount changes yearly), you pay the full cost of the orthotic until the deductible is satisfied. After that, Medicare pays 80% of the approved amount and you pay 20%. For example, if the Medicare-approved amount is $500, you would pay $100 (20% of $500) after meeting your deductible. If your Medigap or Medicare Advantage plan covers Part B coinsurance, your plan may pay some or all of that $100.

The actual cost of a custom orthotic typically ranges widely depending on the complexity of your foot structure and the materials used, but the Medicare-approved amount is usually lower than the orthotist's full charge. Ask the orthotist for an estimate of both the full cost and the Medicare-approved amount before you proceed.

Medicare Advantage plans and orthotics

If you have a Medicare Advantage plan (Part C), your coverage for orthotics may differ from Original Medicare. Some Advantage plans cover custom orthotics under the same rules as Original Medicare, while others may require prior authorization, limit the number of devices, or have different cost-sharing. A few plans do not cover orthotics at all.

Contact your Advantage plan directly before seeing your doctor. Ask whether orthotics for plantar fasciitis are covered, whether you need prior authorization, and what your out-of-pocket cost will be. Your plan's member services phone number is on your insurance card. Having this information in advance prevents surprises when you receive your bill.

When to appeal a denial

If Medicare denies your orthotic claim, you have the right to appeal. The denial notice will explain the reason — for example, that the device was not prescribed by a physician, that conservative treatments were not documented, or that the orthotist is not enrolled in Medicare. Read the notice carefully to understand why the claim was denied.

If you believe the denial is wrong, you can file an appeal within 120 days of the denial notice. Your orthotist or doctor can help you gather the documentation needed to support your appeal, such as medical records showing your treatment history or a letter from your doctor explaining why the orthotic is medically necessary. Many appeals are successful when the right documentation is provided.

Frequently Asked Questions

Can my podiatrist prescribe an orthotic that Medicare will cover?

In most cases, no. Medicare considers podiatrists as specialists in foot care but not as physicians for the purpose of prescribing orthotics. However, if your podiatrist works in a hospital outpatient clinic or federally may have access to health center and a physician co-signs the prescription, Medicare may cover it. Ask your podiatrist whether they work in such a setting.

Do I need to try physical therapy before getting an orthotic?

Not necessarily physical therapy specifically, but your doctor must document that you tried conservative treatments first — such as rest, stretching, ice, anti-inflammatory medication, or activity modification. If you have done these things on your own, tell your doctor so they can note it in your medical record.

How long does it take to get a custom orthotic approved by Medicare?

The process typically takes two to four weeks from the time your doctor writes the prescription. The orthotist needs time to mold or scan your foot, fabricate the device, and submit the claim to Medicare. Medicare then processes the claim, which usually takes one to two weeks. Ask your orthotist for a timeline when you place your order.

What if my orthotic costs more than the Medicare-approved amount?

You are responsible for the difference between what the orthotist charges and what Medicare approves. This is called "balance billing." Before you order, ask the orthotist for the full charge and the Medicare-approved amount so you know your total out-of-pocket cost. Some orthotists will adjust their charge to match the Medicare-approved amount.

Can I get a replacement orthotic if mine wears out before five years?

Medicare covers a replacement only once every five years under normal circumstances. If your orthotic breaks due to a defect in materials or workmanship, the orthotist may repair or replace it under warranty at no cost to you. If it straightforward wears out, you would pay out of pocket for a replacement before the five-year mark.