Getting Medicare to Pay for Orthotics: What You Need to Know

Medicare covers orthotics only if a doctor prescribes them for a specific medical reason, and only certain types may have access to

Medicare Part B pays for custom-made orthotics — shoe inserts, braces, and similar devices — but not off-the-shelf versions you buy at a drugstore. Your doctor must write an order stating that the orthotic is medically necessary to treat a condition like diabetes, arthritis, or a foot deformity. Medicare then pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers it.

The device must be made specifically for you by a licensed orthotist or prosthetist, not a general medical supplier. Medicare will not pay for orthotics that are primarily for comfort, sports performance, or cosmetic reasons. If your doctor thinks an orthotic would help but you are unsure whether Medicare will cover it, ask your doctor's office to contact Medicare before you order the device — this takes a few days but prevents paying out of pocket for something that will not be covered.

Key Takeaways

Your doctor must prescribe the orthotic in writing and state the medical reason it is needed.
The device must be custom-made by a licensed orthotist or prosthetist, not purchased off-the-shelf.
Medicare pays 80 percent of the approved amount after your Part B deductible; you pay 20 percent.
Ask your doctor's office to check with Medicare before you order to confirm the device will be covered.
Orthotics for comfort, sports, or appearance alone are not covered by Medicare.

What counts as an orthotic under Medicare rules

Medicare covers custom orthotics that are made to fit your foot or body and correct a medical problem. This includes shoe inserts for flat feet or high arches caused by diabetes or arthritis, ankle braces for instability, knee braces for arthritis or injury, and spinal braces for back problems. The device must be ordered by a doctor and made by a licensed orthotist or prosthetist — someone with credentials like CPO (Certified Prosthetist-Orthotist) or LPO (Licensed Prosthetist-Orthotist), depending on your state.

Medicare does not cover compression socks, over-the-counter arch supports, shoe inserts you buy at a pharmacy, or braces sold in a general medical supply store without a custom fitting. It also does not cover orthotics made primarily for athletic performance, even if a doctor writes an order. If you are unsure whether a specific device qualifies, the orthotist's office can check with Medicare before you place an order.

How to get your doctor to prescribe an orthotic

Start by telling your doctor about foot, ankle, knee, or back pain or problems with balance and walking. Your doctor will examine you and may order X-rays or other tests to understand what is causing the problem. If your doctor thinks an orthotic would help, they will write an order that includes the type of device, the reason it is medically necessary, and your diagnosis code.

The order goes to an orthotist or prosthetist, who will measure you and create a custom device. Before the orthotist sends the finished device to you, they will submit the order and measurements to Medicare for approval. This step is called a "prior authorization" and usually takes five to ten business days. Medicare will say yes, no, or ask for more information from your doctor. Once Medicare approves it, you can pick up or receive the device and pay your 20 percent share.

What you pay and how to use your deductible

Medicare Part B has an annual deductible — the amount you must pay out of pocket before Medicare starts paying its share. Once you meet the deductible, Medicare pays 80 percent of the approved amount for the orthotic, and you pay 20 percent. The approved amount is set by Medicare, not by what the orthotist charges, so your actual cost depends on the device and the approved price.

If you have already met your Part B deductible earlier in the year, you will pay only 20 percent of the approved amount. If you have not met it yet, you will pay the full cost of the orthotic until the deductible is reached, then Medicare starts paying 80 percent. Keep track of what you have paid toward your deductible — your Medicare statements show this. If you have a Medigap plan, it may cover some or all of your 20 percent share, so check your plan documents or call your Medigap insurer.

Medicare Advantage plans and orthotic coverage

If you have a Medicare Advantage plan instead of Original Medicare, your coverage for orthotics may be different. Some Medicare Advantage plans cover orthotics the same way Original Medicare does; others cover more types of devices or charge a different copay instead of 20 percent. A few plans do not cover orthotics at all. You need to check your plan's coverage document or call the plan directly to find out what is covered.

When you call your Medicare Advantage plan, ask specifically whether custom orthotics are covered, what your out-of-pocket cost will be, and whether you need prior authorization. If your plan does not cover the orthotic your doctor recommends, you can ask your doctor whether a different type of device might be covered, or you can pay out of pocket. Some people switch to Original Medicare during the annual open enrollment period if their plan does not cover something they need, though this is only possible once a year.

What to do if Medicare denies coverage

If Medicare says no to your orthotic, the orthotist's office will send you a notice called a "information Notice" that explains why. Common reasons for denial are that the device is not considered medically necessary, the diagnosis does not meet Medicare rules, or the order did not include enough detail about why the orthotic is needed.

You have the right to ask Medicare to reconsider. This is called an "appeal." The orthotist's office can help you file an appeal, or you can do it yourself by following the instructions on the information Notice. You have 120 days from the date of the notice to file. If you appeal, send any additional information from your doctor that explains why the orthotic is medically necessary — for example, notes about your pain, your walking problems, or how the orthotic will help you function. Many denials are overturned on appeal when the doctor provides more detail.

Finding an orthotist and checking coverage before you order

Ask your doctor for a referral to an orthotist or prosthetist in your area. Your doctor may have a preferred provider they work with regularly. You can also search the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) website to find certified professionals near you. When you call an orthotist's office, tell them you have Medicare and ask whether they accept Medicare assignment — this means they bill Medicare directly and you pay only your share.

Before you schedule an appointment or place an order, ask the orthotist to contact Medicare with your doctor's order to see whether the device will be covered. This takes a few days but is worth the wait. The orthotist can tell you whether Medicare will pay, what the approved amount is, and what you will owe. If the orthotist says Medicare will not cover it, you can decide whether to pay out of pocket, ask your doctor about alternatives, or get a second opinion from another orthotist.

Frequently Asked Questions

Do I need a referral from my primary care doctor to see an orthotist?

No, you do not need a referral to see an orthotist. However, you do need a written order from a doctor stating that the orthotic is medically necessary. This can come from your primary care doctor, a podiatrist, a rheumatologist, or any other licensed physician. The orthotist will ask you to bring this order to your first appointment.

Can I use my Medigap plan to cover the 20 percent I owe for an orthotic?

It depends on which Medigap plan you have. Some plans cover 20 percent coinsurance; others do not. Check your Medigap plan documents or call your insurer to ask whether orthotics are covered. If your plan covers them, you may owe nothing out of pocket after Medicare pays its share.

What if my doctor says I need orthotics but Medicare says they are not medically necessary?

You can appeal Medicare's decision by submitting additional information from your doctor explaining why the orthotic is necessary for your health. You have 120 days to file an appeal. Many denials are overturned when doctors provide detailed notes about your condition and how the orthotic will help you walk, reduce pain, or prevent injury.

Are custom orthotics covered if I have diabetes?

Yes, Medicare covers custom orthotics for people with diabetes if a doctor prescribes them to prevent or treat foot problems caused by diabetes. Diabetic neuropathy (nerve damage) and other diabetes-related foot conditions often may have access to. Your doctor must document the diabetes-related reason in the order.

How long does it take to get an orthotic after Medicare approves it?

Prior authorization usually takes five to ten business days. Once Medicare approves it, the orthotist will make the custom device, which typically takes one to three weeks. The total time from your first appointment to picking up the finished orthotic is usually four to six weeks.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.