Medicare covers some orthotics, but not all, and the amount you pay depends on which type you need and whether your doctor orders it the right way

Medicare Part B covers orthotics — braces, shoe inserts, compression sleeves, and similar devices — when a doctor orders them as medically necessary and you get them from a Medicare-approved supplier. You typically pay 20 percent of the cost after you meet your Part B deductible. However, Medicare does not cover all orthotics equally. Some are covered only under specific conditions, some require prior approval from Medicare, and some are not covered at all.

The difference between what Medicare will and will not pay often comes down to whether the device is considered a standard medical supply or a custom-made item, and whether your condition meets Medicare's rules for that particular device. Understanding these rules before you buy can save you hundreds of dollars.

Key Takeaways

  • Medicare Part B covers orthotics like foot braces, knee braces, and compression garments when ordered by a doctor and purchased from a Medicare-approved supplier, with you paying 20 percent after your deductible.
  • Custom-made orthotics require a detailed written order from your doctor that explains why the device is medically necessary for your specific condition.
  • Some orthotics, including most shoe inserts and certain compression items, are not covered by Medicare even with a doctor's order.
  • Medicare may require prior authorization before you purchase certain orthotics, so checking with your supplier or Medicare before buying can prevent unexpected out-of-pocket costs.
  • If Medicare denies coverage, you can request a detailed explanation and appeal the decision if you believe it was made in error.

Which orthotics Medicare typically covers

Medicare covers orthotics that are ordered by a doctor and deemed medically necessary to treat a specific condition. The most commonly covered items include knee braces, ankle braces, wrist braces, back braces, and compression garments for lymphedema or venous insufficiency. Foot orthotics — custom inserts placed inside shoes — are covered only in limited cases, usually when prescribed for severe diabetic foot conditions or significant structural problems documented by imaging.

The key requirement is that your doctor must write an order that explains the medical reason for the device. A generic prescription like "knee brace" is not enough. Your doctor needs to document the diagnosis, describe why the specific type of brace is necessary, and confirm that it is not primarily for comfort or cosmetic reasons. This documentation is what Medicare reviewers use to decide whether to cover the cost.

Standard, off-the-shelf orthotics that fit most people are more likely to be covered than custom-made ones, though custom devices are covered if your condition requires them. The difference in price can be significant — a standard ankle brace might cost $50 to $150, while a custom-molded version can run $300 to $800 or more.

Orthotics Medicare does not cover

Medicare does not cover orthotics purchased over the counter for general support or comfort, even if a doctor recommends them informally. Shoe inserts marketed for arch support, heel pain, or general foot comfort fall into this category. Compression socks and sleeves for mild swelling or travel are also typically not covered unless they are prescribed for a specific medical condition like lymphedema.

Orthotics that are considered part of a shoe — such as built-in arch supports or heel lifts — are not covered separately. If you need a special shoe with orthotics built in, Medicare may cover the shoe under its prosthetic and orthotic benefit, but you will need documentation from your doctor and approval from Medicare before purchase.

Devices used primarily for sports performance, injury prevention in healthy people, or cosmetic alignment are not covered. If your doctor prescribes an orthotic mainly to improve your appearance or prevent future injury rather than to treat an existing medical condition, Medicare will deny the claim.

How to get Medicare coverage for orthotics

Start by talking to your doctor about whether an orthotic device would help your condition. If your doctor agrees, ask them to write a detailed order that includes your diagnosis, the specific device needed, and why it is medically necessary. This written order is essential — without it, Medicare will almost certainly deny the claim.

Next, find a Medicare-approved supplier. Not all medical supply companies are approved by Medicare. You can search for approved suppliers in your area on the Medicare website or by calling 1-800-MEDICARE. When you contact the supplier, tell them you have Medicare and ask whether they need prior authorization from Medicare before you purchase the device. Some orthotics require pre-approval; others do not.

Once you have the device, the supplier will submit the claim to Medicare on your behalf. Medicare will review the order and your medical records to decide whether to cover it. If approved, you pay 20 percent of the Medicare-approved amount after you meet your Part B deductible for the year. If Medicare denies the claim, the supplier will send you a notice explaining the reason.

What you will pay out of pocket

If Medicare covers your orthotic, you pay 20 percent of the Medicare-approved cost after your Part B deductible. The deductible for Part B in 2024 is $240, though this amount may change each year. So if an orthotic costs $500 and Medicare approves it, you would pay $240 (deductible) plus 20 percent of the remaining $260, which equals $292 total.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20 percent coinsurance, and some Medicare Advantage plans cover orthotics with a fixed copay. Check your plan documents or call your plan to find out what you will owe.

If Medicare does not cover the orthotic, you pay the full cost yourself. This is why checking coverage before you buy is important. If a supplier tells you Medicare will not cover a device, ask them to explain why and whether you can appeal.

When Medicare requires prior authorization

Some orthotics require prior authorization — Medicare's approval before you purchase the device. If prior authorization is required and you buy the device without getting it first, Medicare may deny the claim and you will owe the full cost. Your supplier should know which devices require prior authorization and will usually request it on your behalf.

Prior authorization typically takes one to two weeks. During this time, Medicare reviews your doctor's order and medical records to confirm the device is medically necessary. If Medicare approves it, you can move forward with the purchase. If Medicare denies it, you will know before you spend money.

Always ask your supplier whether prior authorization is needed before you buy. If they are unsure, call Medicare at 1-800-MEDICARE and provide your doctor's order. Medicare can tell you in one call whether the device requires pre-approval.

What to do if Medicare denies coverage

If Medicare denies your claim, you will receive a notice called a Explanation of Benefits (EOB) that explains the reason. Common reasons for denial include: the device was not ordered by a doctor, the doctor's order did not explain medical necessity, the device is not on Medicare's covered list, or the supplier was not Medicare-approved.

You have the right to appeal a denial. To appeal, you must request it in writing within 180 days of the denial notice. Include a copy of the denial notice, your doctor's order, and any additional medical records that support the medical necessity of the device. Send your appeal to the address listed on the denial notice.

If you believe the denial was made in error — for example, if your doctor's order clearly explained medical necessity but Medicare said it did not — an appeal is worth pursuing. Many denials are overturned on appeal because the initial reviewer did not have complete information.

Frequently Asked Questions

Does Medicare cover compression socks?

Medicare covers compression garments only when prescribed for a specific medical condition such as lymphedema, venous insufficiency, or severe swelling from a documented medical cause. Compression socks bought over the counter for general comfort or travel are not covered. Your doctor must write an order explaining the medical reason for the garment.

Will Medicare pay for custom orthotics or only standard ones?

Medicare covers both custom and standard orthotics if they are medically necessary and ordered by a doctor. Custom orthotics are more expensive but may be covered if your condition requires them. Standard orthotics are more likely to be approved quickly because they cost less and are easier for Medicare to verify.

Do I need to use a specific supplier, or can I buy orthotics anywhere?

You must use a Medicare-approved supplier for Medicare to cover the cost. If you buy from a non-approved supplier, Medicare will not pay, even if your doctor ordered the device. Search for approved suppliers on the Medicare website or ask your doctor for a referral to one in your area.

What happens if my doctor orders an orthotic but Medicare says it is not medically necessary?

You can appeal the denial by requesting a review within 180 days. Include your doctor's order and any medical records that support the need for the device. If your doctor believes the denial was wrong, ask them to write a more detailed explanation of why the orthotic is medically necessary for your specific condition and include that with your appeal.

Does Medicare Part D cover orthotics?

No. Part D covers prescription medications only. Orthotics are covered under Part B as durable medical equipment and orthotics. If you have questions about your coverage, call the number on your Medicare card or contact 1-800-MEDICARE.