Medicare Coverage for Diabetic Shoes and Inserts

For people with diabetes, foot problems are one of the most serious and preventable complications, and Medicare has a specific benefit designed to help. Under Part B, Medicare covers therapeutic shoes and inserts for beneficiaries with diabetes who have certain qualifying foot conditions. It is a modest but genuinely useful benefit that a lot of people never claim, either because they do not know it exists or because the paperwork requirements were not handled correctly. Here is how the benefit works, who qualifies, and what you need to do to get it covered.

Bryce's Take

This is one of those small benefits that never gets talked about, and yet for someone with diabetes it can genuinely help prevent a foot ulcer. The catch is almost always the paperwork. I have seen qualified people get denied simply because the certification from the diabetes doctor and the prescription from the fitter did not match up. If you have diabetes and think you might qualify, get the documentation coordinated up front, and if you are picking a plan, let us make sure it gives you good access to the supplies and providers you need.

What the therapeutic shoe benefit includes

Medicare Part B covers, per calendar year, one pair of therapeutic shoes and inserts for people with diabetes who meet the qualifying criteria. Depending on your situation, that generally means either one pair of custom-molded shoes and inserts or one pair of depth shoes, along with additional inserts. The benefit is meant to reduce the risk of foot ulcers and other complications that can lead to serious wounds or amputation in people with diabetes. It is a preventive-minded benefit, so the goal is to protect feet that are already at elevated risk.

Who qualifies

To be eligible, you must have diabetes and at least one qualifying foot condition, such as a history of foot ulceration, nerve damage with signs of callus formation, poor circulation, foot deformity, or a prior partial or complete foot amputation. On top of that, the benefit has specific certification requirements. The doctor treating your diabetes must certify that you meet the conditions and that you need therapeutic shoes, and a qualified provider such as a podiatrist must prescribe and fit the shoes and inserts. Both pieces have to be in place for the benefit to be covered.

What you pay

For covered therapeutic shoes and inserts, you generally pay 20 percent of the Medicare-approved amount after you have met your Part B deductible, and Medicare pays the remaining 80 percent. To pay the lowest cost, the supplier must accept Medicare assignment, meaning they agree to the Medicare-approved amount as full payment. If you use a supplier that does not accept assignment, you can end up paying more. If you have a Medigap plan, it may cover that 20 percent coinsurance, reducing or eliminating your out-of-pocket cost for the shoes.

The documentation that makes or breaks the claim

This benefit gets denied more often for paperwork reasons than for eligibility reasons. Medicare requires that the physician managing your diabetes certifies your need, that a qualifying foot condition is documented, and that the prescribing and fitting is done by an appropriate provider. If any of that documentation is missing or inconsistent, the claim can be rejected even when you clearly qualify. Before you order shoes, make sure your diabetes doctor and the fitting provider have coordinated on the certification and prescription so the paperwork lines up. On a Medicare Advantage plan, also confirm whether prior authorization or an in-network supplier is required.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.