What Medicare covers for diabetic shoes

Medicare Part B covers diabetic shoes and custom orthotics if you have diabetes and meet specific medical requirements. The program pays 80% of the approved amount after you meet your Part B deductible. You pay the remaining 20%, unless you have a Medigap or Medicare Advantage plan that covers this cost-sharing.

Medicare does not cover shoes off the shelf, even if they are marketed as diabetic shoes. The shoes must be custom-made for your feet by a podiatrist, orthotist, or other may have access to provider. The shoes are considered medical equipment, not regular footwear, because they are prescribed to prevent serious foot complications from diabetes.

You are limited to one pair of shoes and three pairs of inserts (or orthotics) per calendar year. If you need a second pair of shoes in the same year, you must have a documented medical reason that Medicare reviews separately.

Key Takeaways

  • Medicare Part B pays 80% of custom diabetic shoes after your deductible, but only if a doctor prescribes them and you meet medical criteria.
  • The shoes must be custom-made by a may have access to provider — drugstore diabetic shoes do not may have access to.
  • You get one pair of shoes and three pairs of inserts per year; a second pair requires separate medical justification.
  • Your provider must be enrolled in Medicare and bill Medicare directly for the coverage to explore.
  • If you have a Medigap or Medicare Advantage plan, check your plan documents to see whether it covers the 20% you owe.

Medical requirements Medicare uses

Your doctor must document that you have diabetes and that you have one of these foot conditions: a history of foot ulcers, calluses, or corns; significant structural foot abnormality; or poor circulation in your feet. straightforward having diabetes is not enough — Medicare requires evidence that your feet are at high risk for serious injury or infection.

Your doctor does not have to be an endocrinologist or podiatrist, but they must be a Medicare-enrolled provider who can write the prescription. Many primary care doctors can do this. If your doctor is unsure whether you meet the criteria, ask them to document your foot condition in your medical record and discuss whether a prescription makes sense for you.

The prescription must state that the shoes are medically necessary and must include details about your foot condition. When you take the prescription to the shoe provider, they will verify it with Medicare before making the shoes.

How to get diabetic shoes covered

Start by talking to your doctor about whether custom diabetic shoes would help you. Bring up any foot pain, numbness, sores, or swelling you have noticed. If your doctor agrees that you need them, ask for a written prescription that includes your diagnosis and the reason the shoes are medically necessary.

Next, find a shoe provider who is enrolled in Medicare. This can be a podiatrist's office, an orthotics and prosthetics company, or a medical supply store. Call ahead and ask whether they accept Medicare and whether they will bill Medicare directly. Some providers require you to pay upfront and then submit a claim yourself, which is slower and riskier.

Bring your prescription and your Medicare card to your appointment. The provider will take measurements and molds of your feet, then send the prescription and your information to Medicare for approval before they make the shoes. This step usually takes one to two weeks. Once Medicare approves, the provider will custom-make your shoes, which typically takes another two to three weeks.

After you receive the shoes, you will get a bill for 20% of the Medicare-approved amount. If you have a Medigap plan, submit the bill to them and they may cover this cost-sharing. If you have a Medicare Advantage plan, check your plan documents first — some plans cover diabetic shoes differently or have different cost-sharing.

What happens if Medicare denies your request

Medicare may deny coverage if your doctor's prescription does not clearly document a medical need, if your provider is not Medicare-enrolled, or if you have already used your yearly allowance. If you receive a denial letter, read it carefully to understand the reason.

You have the right to appeal. Contact your provider's office and ask them to help you gather additional medical documentation — for example, photos of foot sores, notes from your podiatrist about your foot structure, or records of previous foot problems. Your doctor can also write a letter explaining why the shoes are medically necessary for you specifically.

Send the appeal and new documentation to the address listed on the denial letter within 180 days. This process can take several weeks, so ask your provider whether they will hold your custom shoes while the appeal is pending.

Medicare Advantage plans and diabetic shoes

If you have a Medicare Advantage plan instead of Original Medicare, your coverage for diabetic shoes may be different. Some Advantage plans cover them the same way Part B does (80% after deductible), while others may have different cost-sharing, require prior approval, or limit you to certain providers.

Check your plan's Summary of Benefits or call the plan's customer service number before you see your doctor. Ask specifically whether diabetic shoes are covered, what the cost-sharing is, and whether you need prior approval. This step takes 10 minutes and can save you from an unexpected bill.

If your Advantage plan does not cover diabetic shoes, you cannot switch to Original Medicare until the next open enrollment period (October 15 to December 7 each year), unless you may have access to for a special enrollment period due to a life event.

Alternatives if Medicare does not cover your shoes

If you do not meet Medicare's medical criteria or have already used your yearly allowance, you can purchase diabetic shoes out of pocket. Prices range widely depending on the provider and the level of customization, but custom shoes typically cost between $400 and $800 per pair.

Some nonprofit organizations and local diabetes programs offer discounted or donated shoes to people with diabetes who cannot afford them. Contact your local hospital's diabetes education program or search for "free diabetic shoes near me" to see what is available in your area. The American Diabetes Association website also lists local resources.

If cost is a barrier, ask your doctor whether over-the-counter diabetic shoes (which Medicare does not cover) might help in the short term while you work toward meeting Medicare's criteria for custom shoes. Your podiatrist can recommend brands that provide good support and cushioning.

What to ask your doctor

Before your appointment, write down any foot problems you have had: pain, numbness, tingling, sores, swelling, or changes in color. During the visit, ask your doctor these questions:

  • Do I have a foot condition that makes custom diabetic shoes medically necessary?
  • Will you write a prescription for custom diabetic shoes and include the medical reason?
  • Can you recommend a Medicare-enrolled shoe provider in my area?
  • If Medicare denies the request, will you help me appeal with additional documentation?

When to contact Medicare directly

Call Medicare at 1-800-MEDICARE (1-800-633-4227) if you have questions about your coverage or if you receive a denial letter. Have your Medicare number ready. Medicare staff can tell you whether a specific provider is enrolled and can explain why a claim was denied.

You can also visit Medicare.gov and use the "Find Care Providers" tool to search for podiatrists and orthotists in your area who accept Medicare. This tool shows you whether each provider is enrolled and accepting new patients.

Frequently Asked Questions

Can I buy diabetic shoes at a drugstore and have Medicare pay for them?

No. Medicare only covers shoes that are custom-made for your specific feet by a may have access to provider. Shoes sold in stores, even if labeled as diabetic shoes, do not meet Medicare's requirements because they are not prescribed by a doctor or made to your measurements.

What if my podiatrist is not enrolled in Medicare?

You can still see that podiatrist, but Medicare will not cover the shoes. You would pay the full cost out of pocket. Ask your podiatrist whether they are enrolled in Medicare before your appointment, or call Medicare at 1-800-MEDICARE to check.

Do I have to pay anything upfront, or does the provider bill Medicare first?

A Medicare-enrolled provider should bill Medicare directly before you pay anything. You will receive a bill for 20% of the approved amount after Medicare processes the claim. If a provider asks you to pay the full cost upfront, ask whether they will bill Medicare and refund you the difference.

Can I get a second pair of shoes in the same year?

Medicare allows one pair per year normally. A second pair requires separate medical justification — for example, if your first pair wears out faster than expected due to your foot condition, or if you need different shoes for different activities. Your doctor and provider must submit this request to Medicare separately.

What if I have both Original Medicare and a Medigap plan?

Original Medicare pays 80% after your deductible, and your Medigap plan may cover the remaining 20%, depending on which Medigap plan you have. Check your Medigap plan documents or call the plan to confirm. If your Medigap covers this benefit, you may owe nothing out of pocket.