Medicare's coverage of shoes for neuropathy is limited and requires specific conditions

Medicare Part B covers therapeutic shoes for people with diabetes and diabetic neuropathy, but only under strict rules. The shoes must be prescribed by a doctor, made by a may have access to pedorthist or prosthetist, and documented as medically necessary because of nerve damage in your feet. Medicare will not cover regular shoes, even if you have neuropathy from another cause, and it will not cover shoes ordered online or from a general shoe store.

The program pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent. The exact dollar limit and what counts as "approved" varies slightly by region, so your actual out-of-pocket cost depends on where you live and which supplier Medicare has contracted with in your area.

Key Takeaways

  • Medicare Part B covers therapeutic shoes only for people with diabetes and diabetic nerve damage, not neuropathy from other causes.
  • Your doctor must write an order stating the shoes are medically necessary, and a Medicare-approved pedorthist or prosthetist must make or fit them.
  • Medicare pays 80 percent of the approved amount after your deductible; you pay 20 percent out of pocket.
  • You are limited to one pair of shoes and three pairs of inserts per calendar year under Medicare rules.
  • If you have a Medigap or Medicare Advantage plan, your coverage may differ, so check your plan documents before ordering.

Who qualifies for Medicare coverage of therapeutic shoes

You must have a diagnosis of diabetes and documented nerve damage (neuropathy) in your feet. The nerve damage must be significant enough that your doctor believes special shoes will reduce your risk of foot injury or ulcers. straightforward having diabetes or neuropathy is not enough; your doctor must specifically state in writing that the shoes are medically necessary for your condition.

Your doctor does not have to be a podiatrist or specialist—your primary care doctor can write the order. However, the doctor must have examined your feet and documented the neuropathy in your medical record. If your records do not show this documentation, ask your doctor's office to add it before you order shoes.

How to order Medicare-covered therapeutic shoes

First, ask your doctor to write an order for therapeutic shoes for diabetic neuropathy. The order should state that the shoes are medically necessary and describe your foot condition. Your doctor will give you a copy to take to the shoe supplier.

Next, find a Medicare-approved pedorthist or prosthetist in your area. You can search for one on Medicare.gov or call 1-800-MEDICARE to ask for a list of suppliers near you. Not all shoe stores are Medicare-approved, so do not order from a regular shoe retailer even if they sell "diabetic shoes"—Medicare will not pay.

When you visit the supplier, bring your doctor's order and your Medicare card. The supplier will take measurements, fit the shoes, and submit the claim to Medicare on your behalf. You will pay your 20 percent coinsurance at the time of fitting, after Medicare's approved amount is determined. The entire process usually takes two to four weeks from order to delivery.

What Medicare will and will not cover

Medicare covers one pair of therapeutic shoes and up to three pairs of inserts per calendar year. The shoes must be custom-made or custom-fitted to your feet by a may have access to supplier. Inserts can be custom-made or prefabricated, depending on your needs.

Medicare does not cover shoes ordered online, shoes from a regular shoe store, or shoes that are not prescribed by a doctor. It also does not cover replacement shoes if you lose or damage your pair before the year ends. If you need a second pair during the same calendar year, you will pay the full cost yourself.

If you have neuropathy from a cause other than diabetes—such as chemotherapy, spinal cord injury, or vitamin deficiency—Medicare Part B does not cover therapeutic shoes. Some Medigap plans or Medicare Advantage plans may offer additional coverage, so check your plan documents.

What you pay out of pocket

Your cost depends on the approved amount Medicare sets for therapeutic shoes in your region. After you meet your Part B deductible for the year, Medicare pays 80 percent and you pay 20 percent. If you have not met your deductible, you pay the full amount until you do, then Medicare begins paying its share.

The approved amount typically ranges from $400 to $800 per pair, meaning your 20 percent coinsurance could be $80 to $160. If you have a Medigap plan, it may cover some or all of your coinsurance. If you have a Medicare Advantage plan, your cost-sharing may be different—some plans charge a copay instead of coinsurance. Call your plan before ordering to find out your exact cost.

If you have a Medicare Advantage or Medigap plan

Medicare Advantage plans must cover at least what Original Medicare covers, but many offer additional benefits. Some plans cover more than one pair of shoes per year or cover shoes for neuropathy from non-diabetic causes. Check your plan's coverage document or call the plan's customer service line to ask what shoes are covered and what you will pay.

Medigap plans do not typically add shoe coverage beyond what Original Medicare covers, but they may pay your coinsurance. If you have a Medigap plan, it will pay its share after Medicare pays its 80 percent, reducing your out-of-pocket cost.

What to ask your doctor before ordering shoes

Ask your doctor to confirm in writing that you have diabetic neuropathy and that therapeutic shoes are medically necessary for you. Ask whether your neuropathy is from diabetes or another cause, because this affects whether Medicare will pay. If your neuropathy is not from diabetes, ask your doctor whether your insurance plan covers shoes for your specific condition.

Ask your doctor for the name of a Medicare-approved supplier, or ask whether they have a preferred supplier they work with regularly. Some doctors' offices have a relationship with a local pedorthist and can coordinate the order more quickly.

Frequently Asked Questions

Can I order shoes online if my doctor prescribes them?

No. Medicare only pays for shoes that are custom-made or custom-fitted by a Medicare-approved pedorthist or prosthetist in person. Online retailers and mail-order shoe companies are not Medicare-approved suppliers, even if they sell "diabetic shoes." You must visit a supplier in your area.

What if my neuropathy is from chemotherapy, not diabetes?

Medicare Part B does not cover therapeutic shoes for neuropathy caused by chemotherapy, spinal cord injury, or other non-diabetic conditions. Ask your doctor whether your Medicare Advantage plan or supplemental insurance covers shoes for your specific type of neuropathy. Some plans do offer this coverage.

Can I get a second pair of shoes if I wear out the first pair before the year ends?

No. Medicare limits coverage to one pair of shoes per calendar year. If you damage or lose your shoes before December 31, you will pay the full cost for a replacement pair yourself. The calendar year resets on January 1, and you become may be able to access for another pair then.

Do I need a referral to see a pedorthist, or can I go directly?

You do not need a referral, but you do need a written order from your doctor stating that therapeutic shoes are medically necessary. You can contact a Medicare-approved pedorthist directly and ask them to request the order from your doctor's office if you do not have one yet.

Will my Medigap plan pay the 20 percent coinsurance?

Most Medigap plans cover coinsurance for Part B services, which includes therapeutic shoes. Check your plan documents or call your Medigap insurer to confirm. If your plan covers coinsurance, you may pay nothing out of pocket after Medicare pays its 80 percent.