Medicare Part B covers diabetic shoes and custom orthotics if you have diabetes and meet specific medical requirements

Medicare will pay for therapeutic shoes and inserts designed for people with diabetes, but only if a doctor documents that you need them to treat a diabetic foot condition. The shoes are not covered straightforward because you have diabetes — there must be a medical reason related to nerve damage, poor circulation, or a foot deformity caused by diabetes. Medicare pays 80 percent of the approved amount after you meet your Part B deductible, and you pay the remaining 20 percent.

The shoes must be prescribed by a podiatrist or other may have access to physician, and they must be made by an approved supplier. Medicare will not cover regular shoes, even if they are marketed as diabetic shoes. The footwear has to meet specific medical standards and be custom-molded or custom-made for your feet.

Key Takeaways

  • Your doctor must document a diabetic foot condition — such as peripheral neuropathy, poor circulation, or a structural deformity — before Medicare will consider covering shoes.
  • Medicare covers one pair of shoes and up to three pairs of inserts per calendar year, not multiple pairs of shoes.
  • The shoes must be prescribed by a doctor and made by a Medicare-approved supplier; off-the-shelf diabetic shoes do not may have access to.
  • You pay 20 percent of the Medicare-approved amount after meeting your Part B deductible; the exact cost depends on the shoe and your supplier.

What conditions may have access to for coverage

Medicare covers diabetic shoes only when you have one of these documented foot problems: peripheral neuropathy (nerve damage that causes loss of feeling), poor blood circulation in your feet, a history of foot ulcers, foot deformity from diabetes, or previous amputation of part of your foot. Your doctor must write in your medical record that one of these conditions exists and that therapeutic shoes are medically necessary to treat or prevent further damage.

Having diabetes alone is not enough. Many people with diabetes never develop foot complications and do not need special shoes. Medicare's rule is that the shoes must address a specific medical problem, not prevent one that has not yet occurred. If your doctor says you have good foot health despite your diabetes, Medicare will not cover the shoes.

How much Medicare pays and what you owe

Medicare Part B pays 80 percent of the approved amount for diabetic shoes after you have paid your annual deductible. The approved amount varies by region and by the type of shoe or insert. A pair of custom-molded shoes might be approved at $400 to $600, meaning Medicare would pay $320 to $480 and you would pay $80 to $120 (plus any deductible you still owe). Inserts are typically approved at lower amounts, around $100 to $200 per pair.

Your out-of-pocket cost also depends on whether your supplier is in-network with Medicare. An in-network supplier agrees to accept Medicare's approved amount as payment in full for the 20 percent you owe. An out-of-network supplier can charge you more, and you may owe the difference between what they charge and what Medicare approves. Always ask your supplier whether they accept Medicare assignment before you order.

Coverage limits: how many shoes and inserts per year

Medicare covers one pair of shoes and up to three pairs of inserts per calendar year. This means you can get one new pair of shoes in January and another in December if you need them, but Medicare will not pay for a second pair in the same calendar year. The three pairs of inserts can be used with the same shoes or different shoes, and you can spread them across the year or get all three at once.

If you need a replacement shoe because the first one was damaged or lost, you will generally have to wait until the next calendar year unless your doctor documents that the damage was due to a medical event. Wear and tear from normal use does not may have access to for an early replacement.

How to get diabetic shoes covered by Medicare

Start by talking to your doctor — your primary care physician, endocrinologist, or podiatrist — about whether you have a foot condition that requires therapeutic shoes. Your doctor will examine your feet and review your medical history. If they believe you need diabetic shoes, they will write an order that includes the specific condition being treated and a statement that the shoes are medically necessary.

Next, find a Medicare-approved supplier. You can search for suppliers on the Medicare website by entering your ZIP code, or your doctor's office may have a list of suppliers they work with regularly. Contact the supplier and give them your doctor's order. The supplier will measure your feet, discuss shoe options with you, and submit the order to Medicare for approval. This step usually takes one to two weeks. Once Medicare approves the order, you will pick up or receive your shoes and pay your 20 percent coinsurance.

Keep your receipts and any paperwork from your supplier. If Medicare denies the claim, you have the right to appeal, and your documentation will be important.

What happens if Medicare denies your claim

Medicare may deny coverage if your doctor did not document a may have access to foot condition, if the shoes do not meet Medicare's standards, or if you have already used your yearly allowance. If your claim is denied, you will receive a notice called a Medicare Summary Notice (MSN) that explains the reason.

You have 120 days from the date on the notice to file an appeal. You can ask your doctor to provide additional documentation of your condition, or you can ask your supplier to resubmit the claim with more detail. Many denials are overturned on appeal when the doctor provides clearer documentation that the shoes were medically necessary. If you disagree with the appeal decision, you can request a hearing before a Medicare official.

Supplemental insurance and other coverage options

If you have a Medigap or Medicare Advantage plan in addition to Original Medicare, check your plan documents to see whether it covers the 20 percent coinsurance for diabetic shoes. Some Medigap plans cover Part B coinsurance, which would mean you pay nothing out of pocket. Medicare Advantage plans vary widely — some cover diabetic shoes at a lower coinsurance rate, and some do not cover them at all.

If you do not have supplemental coverage and cannot afford the 20 percent coinsurance, ask your supplier whether they offer payment plans or discounts. Some suppliers will work with you on cost, especially if you are a regular customer or if you need multiple pairs of inserts.

Questions to ask your doctor

Before you see your doctor, write down these questions so you remember to ask them:

  • Do I have a foot condition that qualifies for Medicare coverage of diabetic shoes?
  • If yes, will you write an order for therapeutic shoes and send it to a supplier?
  • Do you have a preferred Medicare-approved supplier you work with?
  • How often do I need new shoes — once a year, or more frequently?
  • What should I do to care for my feet at home to prevent future problems?

Frequently Asked Questions

Can I buy diabetic shoes myself and then ask Medicare to reimburse me?

No. Medicare will not reimburse you for shoes you buy on your own, even if they are diabetic shoes. The shoes must be prescribed by your doctor and ordered through a Medicare-approved supplier. The supplier submits the claim to Medicare before you pay, not after.

What if I wear a prosthetic foot or have had an amputation?

If you have had an amputation or wear a prosthetic, you may still be covered for a shoe on your remaining foot if you have a may have access to diabetic foot condition. Talk to your doctor and your prosthetics supplier about whether Medicare will cover a therapeutic shoe as part of your overall care.

Do I need to see a podiatrist, or can my regular doctor prescribe the shoes?

Your regular doctor can prescribe diabetic shoes if they document a may have access to condition. You do not have to see a podiatrist, though some people do. The key is that the prescribing doctor must examine your feet and write that the shoes are medically necessary for a specific reason.

What if I need custom orthotics but not special shoes?

Medicare covers custom-molded inserts (orthotics) separately from shoes. You can get up to three pairs of inserts per year even if you do not get shoes. Your doctor must still prescribe them, and they must be made by a Medicare-approved supplier.

Can I get a new pair of shoes if my old ones wear out before the year ends?

Generally, no. Medicare covers one pair per calendar year, and normal wear does not may have access to for an early replacement. If your shoes are damaged in an accident or by a medical event (such as a severe infection), ask your doctor whether they will document this and request an exception from Medicare.