Medicare's coverage of orthotics depends on the type of device and whether a doctor prescribes it as medically necessary

Medicare Part B covers some orthotics — devices like braces, shoe inserts, and compression sleeves — but not all of them. The key is that a doctor must prescribe the device, and it must treat a specific medical condition rather than provide general comfort or support. Medicare will not pay for orthotics you buy over the counter on your own, even if they seem similar to what a doctor might order.

What Medicare covers falls into two categories: custom-made orthotics (built specifically for your body) and certain prefabricated devices (mass-produced but prescribed by a doctor). The rules differ between them, and the amount Medicare pays depends on which category your device falls into and whether you have met your Part B deductible.

Key Takeaways

  • Medicare Part B covers orthotics only when a doctor prescribes them as medically necessary for a specific condition, not for general comfort or prevention.
  • Custom-made orthotics typically have higher Medicare coverage than prefabricated ones, but you must use a supplier enrolled in Medicare.
  • You are responsible for 20 percent of the cost after you meet your Part B deductible; Medicare pays the other 80 percent.
  • Orthotics for the foot, knee, ankle, hip, and spine are more likely to be covered than devices for other body parts.
  • Your doctor must document why the orthotic is medically necessary, and Medicare may request records before approving payment.

Which orthotics Medicare typically covers

Medicare covers custom-made orthotics for the foot, ankle, knee, hip, and spine when a doctor prescribes them to treat conditions like arthritis, diabetes-related foot problems, or structural deformities. Foot orthotics (shoe inserts) are the most commonly covered type. Knee braces, ankle braces, and spinal braces may also be covered if your doctor documents that they are medically necessary and not just for comfort during sports or exercise.

Prefabricated orthotics — devices made in standard sizes and not custom-fitted to your body — are covered in some cases, but Medicare typically pays less for them than for custom devices. Your doctor can prescribe a prefabricated orthotic if it meets your medical need, but you may have more out-of-pocket cost.

Compression sleeves, elastic bandages, and wraps are generally not covered by Medicare, even with a prescription, because Medicare considers them supplies rather than orthotics. The distinction matters: orthotics are devices that support or correct body function, while supplies are consumable items you replace frequently.

What Medicare does not cover

Medicare does not cover orthotics bought over the counter, even if they are similar to prescription devices. You must obtain the device through a Medicare-enrolled supplier, and a doctor must write the prescription. If you purchase an orthotic on your own and later ask Medicare to reimburse you, the answer will be no.

Orthotics for sports performance, injury prevention, or general comfort are not covered. For example, if you want an orthotic to improve your running form or prevent future problems, Medicare will not pay. The device must treat an existing medical condition that a doctor has documented in your medical record.

Orthotics for conditions Medicare considers cosmetic — such as bunion pads or devices to straighten toes purely for appearance — are not covered. However, if a bunion causes pain or affects your ability to walk, a doctor may prescribe an orthotic to treat the pain, and that could be covered.

How to get Medicare coverage for an orthotic

Start by talking to your doctor about whether an orthotic could help your condition. Your doctor will examine you, review your medical history, and decide whether an orthotic is medically necessary. If your doctor agrees, they will write a prescription that includes the specific type of device, the body part it treats, and the medical reason for it.

Next, take the prescription to a Medicare-enrolled orthotic supplier. You can find suppliers by calling Medicare at 1-800-MEDICARE or searching the Medicare provider directory online. The supplier will measure you, fit the device, and submit the claim to Medicare on your behalf. Do not use a supplier who is not enrolled with Medicare, because Medicare will not pay the claim.

Medicare may request documentation from your doctor before approving the claim. This is normal and does not mean your claim will be denied. The supplier or your doctor's office will handle sending the records. Once Medicare approves the claim, you will owe 20 percent of the approved amount after you meet your Part B deductible for the year.

Your costs: deductible and coinsurance

Your Part B deductible for 2024 is $240 (this amount changes each year). Once you meet the deductible, Medicare pays 80 percent of the approved cost for the orthotic, and you pay 20 percent. The approved cost is what Medicare decides the device is worth, not necessarily what the supplier charges.

If the supplier charges more than Medicare's approved amount, you may owe the difference on top of your 20 percent coinsurance. This is called balance billing. Medicare-enrolled suppliers agree not to balance bill you, so choosing an enrolled supplier protects you from unexpected bills.

If you have supplemental insurance (Medigap) or Medicare Advantage, your coverage of the 20 percent coinsurance may differ. Check your plan documents or call your plan to understand what you will owe out of pocket.

Custom orthotics versus prefabricated devices

Custom orthotics are made specifically for your body based on measurements, molds, or scans. Medicare typically covers a higher percentage of the cost for custom devices because they are more expensive and more precisely fitted to your medical need. Your doctor must prescribe a custom orthotic, and you must obtain it from a Medicare-enrolled supplier who specializes in custom devices.

Prefabricated orthotics are mass-produced in standard sizes. Medicare may cover them if your doctor prescribes them and documents that they meet your medical need. However, Medicare's approved amount for prefabricated devices is usually lower, so your out-of-pocket cost may be higher as a percentage of the total price.

Your doctor will recommend one or the other based on your condition and how well a standard device is likely to work for you. If your doctor recommends a custom orthotic and Medicare denies it, you can ask your doctor to appeal or to explain why a prefabricated device would not be adequate.

What to do if Medicare denies your claim

If Medicare denies coverage for an orthotic, you have the right to appeal. The denial letter will explain why Medicare said no and will tell you how to request a review. You typically have 120 days from the date of the denial to file an appeal.

Common reasons for denial include: the device was not prescribed by a doctor, the supplier was not enrolled in Medicare, the medical reason was not documented clearly enough, or Medicare decided the device was not medically necessary. If the reason was documentation, your doctor can submit additional records to support the appeal.

You can also ask your doctor whether a different type of orthotic might be covered. For example, if Medicare denied a prefabricated device, a custom orthotic might be approved instead, or vice versa. Your doctor and the supplier can work together to find a covered option that still meets your medical need.

Frequently Asked Questions

Does Medicare cover orthotics for diabetes?

Yes, Medicare covers custom orthotics for people with diabetes when a doctor prescribes them to prevent or treat foot complications. Diabetic foot orthotics are among the most commonly covered types because diabetes increases the risk of foot ulcers and infections. Your doctor must document that the orthotic is medically necessary for your diabetic foot condition.

Will Medicare pay for a knee brace or ankle brace?

Medicare may cover knee and ankle braces if a doctor prescribes them to treat a specific condition like arthritis or a ligament injury. The brace must be custom-made or a prescribed prefabricated device, not one you buy yourself. Your doctor will need to document the medical reason and why the brace is necessary for your treatment.

Can I use my Medigap or Medicare Advantage plan instead of Medicare Part B?

No. Orthotics are covered under Medicare Part B, not by Medigap or Medicare Advantage separately. However, your Medigap plan may help pay your 20 percent coinsurance after Medicare pays its 80 percent. Medicare Advantage plans have their own rules for orthotic coverage, so check your plan documents or call your plan to see what you owe.

What if my doctor prescribes an orthotic but I cannot afford the 20 percent?

Talk to your doctor or the orthotic supplier about your cost concerns. Some suppliers offer payment plans. You can also contact your local Area Agency on Aging or a patient information program to learn about other resources. Do not skip the orthotic if your doctor says you need it; instead, explore your options for managing the cost.

Do I need prior approval from Medicare before getting an orthotic?

Not always. Your doctor and supplier can submit the claim after the orthotic is made, and Medicare will review it then. However, for some types of orthotics, your supplier may request prior approval to confirm coverage before you pay. Ask your supplier whether they recommend requesting approval first.