What Medicare covers for diabetic shoes

Medicare Part B covers diabetic shoes and custom orthotics (shoe inserts) if you have diabetes and meet specific medical requirements. The program pays for one pair of shoes and three pairs of inserts per year, or one pair of shoes with inserts already built in. Medicare covers up to 80% of the cost after you meet your Part B deductible, and you pay the remaining 20%.

The shoes must be prescribed by a doctor who is treating your diabetes, and they must be fitted by a podiatrist, orthotist, or prosthetist. Not all shoe styles may have access to — they have to be specially designed to reduce pressure on your feet and prevent ulcers or other complications from diabetes. Regular shoes, even if they are comfortable, do not count.

You cannot straightforward buy shoes online or at a store and ask Medicare to reimburse you. The entire process must go through a Medicare-approved supplier, and your doctor's prescription must include specific medical reasons why you need them.

Key Takeaways

  • Medicare Part B covers one pair of diabetic shoes and three pairs of inserts per year if your doctor prescribes them for diabetes-related foot complications.
  • Your doctor must document that you have diabetes and a foot condition that makes special shoes medically necessary, such as a history of ulcers or severe calluses.
  • The shoes must be fitted by a podiatrist, orthotist, or prosthetist who works with a Medicare-approved supplier.
  • You pay 20% of the approved amount after meeting your Part B deductible; Medicare pays the remaining 80%.
  • Shoes purchased outside the Medicare process or without a prescription will not be covered, even if they are marketed as diabetic shoes.

Medical conditions that may have access to for coverage

Medicare does not cover diabetic shoes for everyone with diabetes. Your doctor must document that you have one of several foot-related complications or risk factors. These include a history of foot ulcers, severe calluses, corns, or bunions caused by diabetes; significant foot deformity from diabetes; or poor circulation in your feet.

You also may have access to if you have had an amputation related to diabetes, or if you have significant pain or swelling in your feet that limits your ability to walk. Your doctor needs to write down the specific reason in your medical record — a general note that you have diabetes is not enough.

If you have diabetes but no foot complications yet, Medicare will not cover the shoes. Prevention alone is not considered a covered reason, even though special shoes can help prevent problems. This is an important distinction: the shoes must address an existing condition, not prevent a future one.

How to start the process with your doctor

Begin by scheduling an appointment with the doctor who manages your diabetes — this is usually your primary care physician or an endocrinologist. Tell them you are interested in diabetic shoes and ask whether your feet meet Medicare's criteria. Bring a list of any foot problems you have had: ulcers, sores that heal slowly, numbness, pain, or swelling.

Your doctor will examine your feet and review your medical history. If they believe you may have access to, they will write a prescription that includes the medical reason the shoes are necessary. The prescription should be specific — for example, "diabetic neuropathy with history of plantar ulcer" rather than just "diabetes."

Ask your doctor for a list of Medicare-approved suppliers in your area, or ask them to send the prescription directly to a supplier you choose. Some doctors' offices have relationships with specific suppliers and can coordinate the fitting appointment for you. Do not buy shoes before you have this prescription in hand.

Working with a Medicare-approved supplier

Once you have your prescription, contact a Medicare-approved supplier — usually a podiatry office, orthotic clinic, or medical supply company. You can search for suppliers on the Medicare website by entering your ZIP code, or ask your doctor's office for a referral.

When you call, tell the supplier you have a prescription for diabetic shoes and ask whether they accept Medicare. Confirm that they are a Medicare-approved supplier, because non-approved suppliers cannot bill Medicare even if they sell diabetic shoes.

At your fitting appointment, the supplier will measure your feet, discuss your specific foot problems, and show you shoe options that meet Medicare's requirements. They will also fit your custom inserts if you are getting those. The supplier handles all the paperwork to send to Medicare — you do not submit the claim yourself.

Before you leave, ask the supplier what your out-of-pocket cost will be. They should be able to tell you the Medicare-approved amount, what your 20% share is, and whether you have already met your Part B deductible for the year.

What you will pay out of pocket

Your cost depends on whether you have met your Part B deductible for the year. The Part B deductible changes each year; you can find the current amount on your Medicare card or the Medicare website.

Once you meet the deductible, Medicare pays 80% of the approved amount for the shoes and inserts, and you pay 20%. The approved amount is set by Medicare, not by the supplier's list price. If a supplier charges more than the approved amount, you are responsible only for your 20% share of the approved amount, not the difference.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your 20% share. Check your plan documents or call your plan to ask what diabetic shoes cost under your coverage.

Limits on how often you can get new shoes

Medicare limits coverage to one pair of shoes and three pairs of inserts per calendar year, or one pair of shoes with inserts already built in. This means you cannot get a new pair every month or even every few months, even if your feet change or your shoes wear out.

If you need shoes more often because of rapid foot changes or severe wear, talk to your doctor about whether they can document a medical reason for more frequent replacement. Medicare may cover additional shoes in cases of significant foot deformity or rapid progression of complications, but this requires special documentation.

The yearly limit resets on January 1. If you received shoes in November, you can get another pair starting in January of the next year.

What happens if your doctor will not prescribe them

If your doctor says you do not meet the criteria for diabetic shoes, you have a few options. You can ask for a second opinion from another doctor, such as a podiatrist or endocrinologist, who may evaluate your feet differently.

You can also purchase diabetic shoes on your own without Medicare coverage. Many shoe companies and medical supply stores sell shoes designed for people with diabetes, and prices range widely. Some people use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for shoes if they have one of these accounts through their employer or retirement plan.

If you believe Medicare should cover your shoes and your doctor disagrees, you can file a complaint with Medicare, though this process takes time and does not may provide coverage.

Frequently Asked Questions

Can I get diabetic shoes if I have Medicare Advantage instead of Original Medicare?

Yes. Medicare Advantage plans must cover diabetic shoes the same way Original Medicare does. However, you may have different out-of-pocket costs or different suppliers in your plan's network. Call your Medicare Advantage plan to ask which suppliers are covered and what you will pay.

What if I need shoes because of arthritis or bunions, not diabetes?

Medicare covers diabetic shoes only when diabetes is the reason you need them. If your foot problems are caused by arthritis, bunions, or other non-diabetes conditions, Medicare does not cover special shoes. Your doctor would need to document that your foot condition is a direct result of your diabetes.

Do I have to use the supplier my doctor recommends?

No. You can choose any Medicare-approved supplier in your area. Your doctor's prescription can be sent to any supplier you select. It is worth calling a few suppliers to compare their shoe styles and ask about your out-of-pocket cost before you decide.

What if the shoes do not fit well after I get them home?

Contact the supplier right away. Most suppliers will adjust or replace shoes that do not fit properly within a reasonable time frame. Ask about their return or adjustment policy before you leave the fitting appointment.

Can I get diabetic shoes covered if I am on Medicaid instead of Medicare?

Medicaid rules vary by state. Some states cover diabetic shoes and some do not. Contact your state Medicaid office or your Medicaid plan to ask what is covered in your state.