What Medicare Covers for Diabetic Shoes and Orthotics

Medicare covers diabetic shoes and custom orthotics, but only under specific conditions

Yes, Medicare Part B covers diabetic shoes and inserts if you have diabetes and meet certain medical requirements. The program pays for shoes, insoles, and modifications designed to protect your feet from injury and ulcers — a real risk for people with diabetes-related nerve damage or poor circulation. However, coverage is not automatic. Your doctor must document that you need them for a medical reason, and you must use an approved supplier.

Medicare covers up to one pair of shoes per year, plus inserts and modifications. The shoes themselves are typically covered at 80 percent of the approved amount after you meet your Part B deductible. The exact dollar amount varies by region and by supplier, so what you pay out of pocket depends on where you live and which supplier you use.

Key Takeaways

Your doctor must document that you have diabetes and a medical reason for special shoes, such as nerve damage, poor circulation, or a history of foot ulcers.
Medicare covers one pair of shoes per calendar year, plus inserts and modifications, at 80 percent of the approved amount after your deductible.
You must use a supplier enrolled in Medicare and approved to dispense diabetic shoes — not all shoe stores may have access to.
Your doctor's order must be current (usually within the past year) and specific about the type of shoe or insert you need.

What Medicare actually pays for

Medicare Part B covers three things: the shoes themselves, custom insoles or orthotics, and shoe modifications such as extra depth, cushioning, or rocker bottoms. The shoes must be prescribed by your doctor and made specifically for diabetic foot care — regular shoes do not count, even if they are comfortable.

The program pays for one pair per calendar year. If you need a second pair in the same year, you pay the full cost yourself. Inserts and modifications are separate from the shoe allowance, so you may be able to get both in the same year if your doctor orders them.

Medicare does not cover socks, shoe inserts you buy over the counter, or shoes ordered online without a prescription. It also does not cover replacements if you lose or damage your shoes — the one-pair-per-year limit is firm.

Medical requirements your doctor must document

Your doctor needs to establish three things on paper before you can get coverage. First, you must have diabetes — either type 1 or type 2. Second, your doctor must document a medical reason for special shoes, such as peripheral neuropathy (nerve damage), poor circulation, a history of foot ulcers or amputations, or severe deformity. Third, your doctor must state that you are under their care for your diabetes.

The order does not need to be lengthy. A note in your medical record saying "Patient has diabetes with peripheral neuropathy and needs diabetic shoes for ulcer prevention" is enough. Your doctor can write this during a regular visit or a foot exam. If you have not seen your doctor recently, you may need an appointment to get the order — Medicare requires it to be current, usually within the past year.

If you have had a foot ulcer or amputation in the past, that history strengthens your case and makes coverage more straightforward. If you have diabetes but no foot complications yet, your doctor can still order shoes if they document that you have nerve damage or circulation problems that put you at risk.

How to find an approved Medicare supplier

Not every shoe store or orthotic company can bill Medicare for diabetic shoes. The supplier must be enrolled in Medicare and approved to dispense them. You can find approved suppliers through the Medicare Supplier Directory on Medicare.gov. Search for "orthotics and prosthetics" or "diabetic shoes" in your area, and the directory will show you which suppliers are active.

Call the supplier before you go in. Tell them you have a doctor's order for diabetic shoes and ask whether they accept Medicare. Ask what the approved amount is in your region and what you will owe after Medicare pays. Some suppliers charge more than the Medicare-approved amount, and you would pay the difference out of pocket.

Bring your Medicare card, your doctor's written order, and proof of your Part B deductible status (you can call Medicare at 1-800-MEDICARE to confirm). The supplier will handle the paperwork with Medicare — you do not submit it yourself.

What you pay out of pocket

Your cost depends on whether you have met your Part B deductible for the year. If you have not, you pay the full deductible first, then Medicare pays 80 percent of the approved amount and you pay 20 percent. If you have already met your deductible, you pay only the 20 percent coinsurance.

The approved amount varies by region. In some areas it may be $300 to $400 for a pair of shoes; in others it could be higher or lower. The supplier can tell you the exact approved amount before you order. If the supplier charges more than the approved amount, you are responsible for the overage — this is called "balance billing," and it is legal for shoes and orthotics.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20 percent coinsurance. Medicare Advantage plans vary — some cover diabetic shoes at a lower cost-share, and some do not cover them at all. Check your plan documents or call your plan to confirm what you will owe.

Reordering shoes and inserts in future years

You can order a new pair once per calendar year, starting January 1. If you ordered shoes in November, you can order again in January — the year resets. You do not need a new doctor's order every year if your condition has not changed, but the order must still be current. Most suppliers keep a copy of your order on file and can reorder without asking you to get a new one from your doctor.

If your medical condition changes — for example, if you develop a new foot ulcer or your nerve damage worsens — ask your doctor for an updated order. This can help if you need shoes sooner than the annual limit or if you need a different type of shoe or insert.

If you switch suppliers, bring your old order with you or ask the old supplier to send it to the new one. You do not need to start from scratch with a new doctor's order unless your previous order has expired.

What to do if Medicare denies your claim

If the supplier submits a claim and Medicare denies it, you will receive a notice called a Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) explaining why. Common reasons for denial include: your doctor's order was not specific enough, your order was too old, the supplier was not enrolled in Medicare, or Medicare determined you did not have a medical reason for the shoes.

If you believe the denial was wrong, you can ask your doctor to submit a more detailed order or a letter explaining your medical need. Then ask the supplier to resubmit the claim with the new documentation. You have the right to appeal within 120 days of the denial notice — the notice itself will explain how to file an appeal.

If the supplier tells you that Medicare denied the claim and you owe the full cost, ask for a copy of the denial notice before you pay. Do not assume the denial is final — many denials are overturned on appeal, especially if your doctor provides additional medical information.

Frequently Asked Questions

Can I order diabetic shoes online and have Medicare pay for them?

No. Medicare only pays when you order through a supplier enrolled in Medicare. Online retailers and shoe stores that do not bill Medicare directly cannot submit claims on your behalf. You must work with an approved supplier in person or by phone so they can handle the Medicare paperwork.

What if my doctor says I need shoes but I do not have diabetes?

Medicare's diabetic shoe benefit is only for people with diabetes. If you have a different condition that requires special shoes — such as arthritis or a foot deformity — you may be able to get them covered under a different Medicare benefit, but you would need to ask your doctor and supplier about that. Diabetic shoes specifically require a diabetes diagnosis.

Do I have to use the same supplier every year?

No. You can switch suppliers whenever you want. Just make sure the new supplier is enrolled in Medicare. If you are unhappy with the fit, quality, or service from one supplier, you can take your doctor's order to a different one the next year.

Will Medicare pay for custom-molded inserts if I already have shoes?

Yes, inserts and shoe modifications are separate from the shoe allowance. If your doctor orders custom insoles or orthotics, Medicare can cover them even if you already received shoes earlier in the year. The supplier will submit them as a separate claim.

What happens if I lose or damage my shoes before the year is over?

Medicare will not pay for a replacement pair until the next calendar year. The one-pair-per-year limit applies regardless of whether the shoes are lost, damaged, or worn out. If you damage your shoes early in the year, you will need to pay out of pocket for a replacement or wait until January.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.