Medicare covers some orthotics, but not all — and what you pay depends on which type you need and whether your doctor orders it the right way

Medicare Part B covers orthotics (shoe inserts, braces, and other devices that support your joints or spine) only when a doctor writes an order for them and they treat a specific medical condition. Medicare will not pay for orthotics you buy over the counter or for general comfort. You typically pay 20% of the approved cost after you meet your Part B deductible, and the supplier must be enrolled with Medicare.

The catch is that Medicare's rules about which orthotics it will pay for are narrow and specific. A device that helps your arthritis might be covered; the same device bought for general foot pain might not be. Understanding what Medicare considers medically necessary — and what paperwork your doctor needs to provide — can mean the difference between paying nothing and paying the full cost yourself.

Key Takeaways

  • Medicare Part B covers orthotics only when ordered by a doctor for a medical condition, not for comfort or prevention.
  • You pay 20% of Medicare's approved amount after meeting your Part B deductible; the supplier must be Medicare-enrolled.
  • Custom orthotics and off-the-shelf orthotics have different coverage rules, and Medicare may require documentation that the device is medically necessary.
  • Your doctor's order must include the specific diagnosis and reason for the orthotic, not just a general request.
  • If Medicare denies coverage, you can ask your supplier or doctor to appeal, or you can pay out of pocket and ask for an itemized receipt for tax purposes.

What types of orthotics Medicare will and won't cover

Medicare covers custom orthotics — devices made specifically for your feet or body — when a podiatrist or physician orders them to treat a diagnosed condition like diabetes, arthritis, or a foot deformity. The device must be made from a mold or cast of your foot, not a standard size. Medicare also covers some off-the-shelf orthotics (ready-made devices) if your doctor documents that a custom device is not medically necessary and the off-the-shelf version will treat your condition.

Medicare does not cover orthotics for general foot pain, arch support for comfort, or prevention of future problems. It also does not cover orthotics for cosmetic reasons or for athletic performance. Knee braces, ankle braces, and back braces follow similar rules: Medicare covers them only when ordered by a doctor for a specific medical condition, and the supplier must be Medicare-enrolled.

The supplier you choose matters. If you go to a store that is not enrolled with Medicare, Medicare will not pay anything, even if your doctor wrote an order. Before you buy, ask the supplier whether they are a Medicare provider and whether they will bill Medicare directly.

How to get Medicare to cover your orthotics

Start by seeing your doctor — a physician, podiatrist, or other may have access to provider — and describing the problem. The doctor must examine you and decide that an orthotic device is medically necessary to treat your condition. This is not the same as saying you have foot pain; the doctor must document a specific diagnosis (such as diabetic neuropathy, plantar fasciitis related to arthritis, or a structural foot deformity) and explain why the orthotic will help.

Your doctor will then write an order that includes your diagnosis, the type of orthotic needed, and the reason it is medically necessary. Bring this order to a Medicare-enrolled supplier. The supplier will take measurements or a mold of your foot, create or fit the device, and submit the order and documentation to Medicare for payment review. This process usually takes one to two weeks.

Medicare will then decide whether to pay. If approved, you pay 20% of the approved amount (after your Part B deductible is met). If Medicare denies the claim, the supplier should send you a notice explaining why. You can ask your doctor or supplier to appeal the decision, or you can pay out of pocket.

What you will pay out of pocket

If Medicare approves your orthotics, you pay 20% of the amount Medicare allows. The amount Medicare allows varies by region and by the type of device. For example, Medicare might allow $300 for a pair of custom foot orthotics in one state and $280 in another. You would pay $60 or $56, respectively, after your deductible.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your 20% cost-share. Check your plan documents or call your plan to find out what orthotics coverage you have.

If Medicare denies the claim, you are responsible for the full cost unless you signed an Advance Beneficiary Notice (ABN) before the supplier ordered your device. An ABN tells you in advance that Medicare may not pay, and it gives you the choice to pay out of pocket or cancel the order. If you did not sign an ABN and Medicare denies payment, ask the supplier for an itemized receipt showing what you paid; you may be able to deduct it as a medical expense on your taxes.

When Medicare might deny coverage

Medicare denies orthotics claims most often when the doctor's order does not include a specific diagnosis or when the supplier is not Medicare-enrolled. It also denies claims when the condition is not one Medicare considers appropriate for an orthotic (for example, general foot fatigue or mild arch pain without a diagnosed condition).

Another common reason for denial is that the supplier did not submit the right paperwork. Some suppliers are experienced with Medicare claims and know exactly what documentation Medicare needs; others are not. If you are working with a supplier who has never billed Medicare before, ask them to contact Medicare's local contractor before they order your device to confirm what paperwork is required.

If your claim is denied, you have the right to appeal. Your supplier or doctor can file an appeal on your behalf, or you can do it yourself. The appeal process takes several weeks, and you will need to provide additional medical records or documentation to support the claim.

Orthotics covered under Medicare Part D and Advantage plans

Medicare Part D (prescription drug coverage) does not cover orthotics. However, some Medicare Advantage plans (Part C) offer supplemental coverage for orthotics beyond what Original Medicare covers. Some Advantage plans cover orthotics with little or no cost-share, or they may cover devices that Original Medicare does not.

If you have a Medicare Advantage plan, check your plan documents or call your plan's customer service to ask what orthotics are covered and what you will pay. Coverage varies widely from plan to plan, and it changes each year. If your plan covers orthotics, you will usually need to use a supplier in your plan's network.

Questions to ask your doctor before ordering orthotics

Before your doctor writes an order, ask these questions: "Will Medicare pay for this orthotic?" "Do I need a custom device, or will an off-the-shelf device work?" "Which suppliers do you recommend, and are they Medicare-enrolled?" "What diagnosis will you put on the order?" and "If Medicare denies this, what are my options?"

Your doctor may not know the answer to all of these questions — many doctors are not familiar with Medicare's orthotics rules. If your doctor is unsure, ask them to contact a Medicare-enrolled supplier directly to confirm what documentation Medicare needs before they write the order. This step can save you time and money.

Frequently Asked Questions

Do I need a prescription from my doctor to get orthotics, or can I buy them over the counter?

Medicare will only pay if your doctor writes an order. You can buy orthotics over the counter without a prescription, but Medicare will not cover the cost. If you buy them on your own, keep your receipt in case you want to deduct the cost as a medical expense on your taxes.

Will Medicare pay for orthotics if I have diabetes?

Yes, Medicare has special rules for people with diabetes. If you have diabetic neuropathy (nerve damage in your feet) or a foot deformity related to diabetes, Medicare covers custom orthotics and diabetic shoes. Your doctor must document the diagnosis, and you must use a Medicare-enrolled supplier.

What if my doctor says I need orthotics but Medicare denies the claim?

Ask your doctor or supplier to file an appeal and provide additional medical records showing why the orthotic is medically necessary. If the appeal is denied, you can pay out of pocket. Some people choose to pay out of pocket rather than wait for an appeal, especially if they need the device quickly.

Can I use my Medigap plan to pay for orthotics that Medicare denies?

No. Medigap plans only pay for services that Medicare covers. If Medicare denies your orthotics claim, your Medigap plan will not pay either. However, if Medicare approves the claim, your Medigap plan may pay part or all of your 20% cost-share.

How long does it take Medicare to decide whether to pay for orthotics?

Usually one to two weeks after the supplier submits the order and documentation. If Medicare needs more information, the process may take longer. Ask your supplier for a timeline when you place your order.