Medicare's Coverage of Orthotics for Plantar Fasciitis

Medicare Part B covers custom-made orthotics for plantar fasciitis, but only if your doctor prescribes them as medically necessary and they meet specific requirements. The device must be made by a licensed orthotist, ordered by your physician, and documented as treatment for a diagnosed foot condition — not straightforward comfort or prevention. Medicare will not cover over-the-counter inserts, arch supports you buy at a drugstore, or orthotics made without a prescription.

Coverage depends on whether your orthotics are considered "shoes" or "shoe inserts." Custom orthotics that are part of a therapeutic shoe (a specially made shoe with the orthotic built in) fall under Medicare's prosthetic shoe benefit. Orthotics that are separate inserts placed inside regular shoes are covered under the orthotic devices benefit. Both routes require a written order from your doctor, but the paperwork and cost-sharing differ.

You pay 20% of the approved amount after you meet your Part B deductible. Medicare sets the approved amount, and your supplier must accept that as payment in full — they cannot bill you for the difference. If your supplier is not enrolled in Medicare, you may pay the full cost upfront and then request reimbursement, though this is less common.

Key Takeaways

  • Medicare Part B covers custom orthotics for plantar fasciitis when prescribed by a doctor, but not over-the-counter inserts or arch supports.
  • Your doctor must document that the orthotics are medically necessary for your foot condition, not just for comfort or general support.
  • You pay 20% of Medicare's approved amount after meeting your Part B deductible; the supplier cannot charge you more than that.
  • Custom orthotics must be made by a licensed orthotist and ordered through a Medicare-enrolled supplier to be covered.
  • Therapeutic shoes (shoes with orthotics built in) and separate orthotic inserts follow different coverage rules but both require a doctor's prescription.

How to Get Your Doctor's Prescription

Start by seeing your primary care doctor or a podiatrist and describing your plantar fasciitis symptoms — heel pain, especially in the morning or after standing. Your doctor will examine your foot and may order an X-ray or ultrasound to rule out other conditions. If they believe custom orthotics will help, they will write a prescription that includes the specific type of orthotic device you need.

The prescription must state that the orthotics are medically necessary and describe the condition being treated. Your doctor does not need to use the word "medically necessary" — the prescription just needs to show that the device is ordered to treat your diagnosed plantar fasciitis, not for general comfort. Keep a copy of this prescription; you will need it when you contact a supplier.

If your doctor is unsure whether to prescribe orthotics, ask whether they think custom inserts would reduce your pain or improve your function. Some doctors start with other treatments first — physical therapy, anti-inflammatory medication, night splints — before moving to orthotics. That is normal. Medicare does not require you to try other treatments first, but your doctor may recommend it based on your individual situation.

Finding a Medicare-Enrolled Orthotic Supplier

Not all orthotic makers accept Medicare. You need a supplier that is enrolled with Medicare and authorized to dispense orthotics. You can search for suppliers on the Medicare Supplier Directory at dmepos.cms.gov (DMEPOS stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies). Enter your ZIP code and select "Orthotics" as the product category. The directory will show you enrolled suppliers near you.

Call suppliers directly and ask whether they accept Medicare assignment — meaning they accept Medicare's approved amount as full payment and will not bill you for the difference. Most do, but confirming this before you go in saves time and prevents surprise bills. Also ask about their timeline: custom orthotics typically take two to four weeks to make after your measurements are taken.

Bring your prescription and your Medicare card when you visit. The supplier will take measurements or a mold of your foot, discuss the type of orthotic that will work best for your condition, and submit the prescription and documentation to Medicare for approval. Some suppliers handle this paperwork themselves; others may ask you to submit it. Ask who is responsible before you leave.

The Medicare Approval Process

After the supplier submits your prescription and medical documentation, Medicare reviews the claim to confirm that the orthotics meet coverage rules. This review typically takes one to two weeks. Medicare will approve the claim if your doctor's prescription shows medical necessity and the orthotics are being made by a licensed provider.

You will receive a notice called an Explanation of Benefits (EOB) that tells you whether Medicare approved the claim and what you owe. If approved, you pay your 20% cost-sharing when you pick up the orthotics. If Medicare denies the claim, the notice will explain why — usually because the prescription did not clearly document medical necessity or because the supplier was not enrolled in Medicare.

If your claim is denied, ask your doctor to provide additional documentation explaining why the orthotics are medically necessary for your condition. Your supplier can then resubmit the claim with this extra information. You have the right to appeal any denial; your supplier or doctor can help you file an appeal if needed.

What You Will Pay Out of Pocket

Your out-of-pocket cost depends on your Part B deductible and the approved amount Medicare sets for the orthotics. In 2024, the Part B deductible is $240 per year. Once you meet this deductible, you pay 20% of the approved amount for the orthotics.

The approved amount varies based on the type and complexity of the orthotic device. A basic custom orthotic insert might have an approved amount of $300 to $500, meaning you would pay $60 to $100 after your deductible. More complex orthotics can cost more. Your supplier should tell you the approved amount before you proceed, so you know your exact cost-sharing.

If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20% cost-sharing, depending on your plan. If you have a Medicare Advantage plan, your cost-sharing may be different — check your plan documents or call your plan to confirm what you pay for orthotics.

Therapeutic Shoes Versus Orthotic Inserts

Medicare covers two types of foot devices for plantar fasciitis: therapeutic shoes and orthotic inserts. A therapeutic shoe is a specially made shoe with the orthotic support built into the sole and structure of the shoe itself. An orthotic insert is a custom-made insert that you place inside your own regular shoes.

Therapeutic shoes are typically prescribed for people with severe foot conditions or diabetes-related foot problems. For plantar fasciitis alone, most people receive orthotic inserts instead, which are less expensive and easier to use with everyday shoes. However, if your doctor believes a therapeutic shoe is medically necessary for your condition, Medicare will cover it under the same rules.

Both require a doctor's prescription and must be made by a licensed provider. The main difference is that therapeutic shoes come as a complete shoe, while inserts are placed in shoes you already own. Ask your doctor which option they recommend based on your specific situation and how severe your plantar fasciitis is.

Common Reasons Medicare Denies Orthotic Claims

Medicare denies some orthotic claims because the prescription does not clearly state that the device is medically necessary. If your doctor's order straightforward says "custom orthotics" without mentioning your plantar fasciitis diagnosis or explaining why you need them, Medicare may reject it. Make sure your doctor's prescription includes the diagnosis and a brief note about why the orthotics will help your condition.

Claims are also denied when the supplier is not enrolled in Medicare or not authorized to dispense orthotics. Always verify enrollment before you place an order. If you use an unenrolled supplier, you will pay the full cost and will not be reimbursed by Medicare, even if the orthotics are otherwise covered.

Some claims are denied because the orthotics are considered duplicative — meaning Medicare records show you already received orthotics recently. Medicare typically covers one pair of orthotics per year, though exceptions exist if your condition changes or your previous orthotics are no longer functional. If you need a replacement, your doctor can request an exception and explain why.

Frequently Asked Questions

Will Medicare cover over-the-counter shoe inserts or arch supports from a drugstore?

No. Medicare only covers custom-made orthotics prescribed by a doctor and made by a licensed orthotist. Over-the-counter inserts, even if they help your pain, are not covered. You would pay for these out of pocket.

Do I need to try other treatments before Medicare will cover orthotics?

No. Medicare does not require you to try physical therapy, medication, or other treatments first. Your doctor may recommend trying other options before orthotics, but Medicare's rules do not mandate this. If your doctor believes orthotics are the right first step, they can prescribe them.

How long do custom orthotics last, and will Medicare cover a replacement?

Custom orthotics typically last two to five years depending on use and wear. Medicare covers one pair per year, though you may be able to get a replacement sooner if your orthotics break or your condition changes significantly. Your doctor would need to document the reason for the replacement.

What if my podiatrist is not enrolled in Medicare?

Your podiatrist can still prescribe the orthotics. You would then take the prescription to a Medicare-enrolled orthotic supplier to have them made. The supplier must be enrolled for Medicare to cover the cost. If you use an unenrolled supplier, you pay the full amount and Medicare will not reimburse you.

Can I appeal if Medicare denies my orthotic claim?

Yes. You have the right to appeal any denial. Your supplier or doctor can help you file an appeal and provide additional documentation explaining why the orthotics are medically necessary. The appeal process typically takes several weeks, and you can request that the supplier hold your orthotics during this time.