Wearing appropriate shoes is important for people with diabetes since it helps avoid foot sores and infections. But here’s the thing: diabetic shoes may be quite expensive, which can be a source of concern for many people. 

So, are diabetic shoes covered by Medicare? In this blog post, we’ll look at what it takes to be eligible for this benefit.

Are diabetic shoes covered by Medicare?

Yes, Medicare does cover diabetic shoes. You must have Original Medicare, which includes Part A and/or Part B, to be eligible for this benefit. Medicare Part B is the part of Medicare that covers diabetic shoes and the claims are processed by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

Things can get a little more complicated if you have a Medicare Advantage plan, often known as Part C. The Medicare coverage for diabetic shoes and inserts may differ depending on your plan. Therefore, you need to reach out to your plan provider to learn more about what the Medicare Advantage plan has to offer.

How much do diabetic shoes cost?

On average, basic diabetic shoes may start at around $50 to $100. More specialized and custom-made diabetic shoes can range from $100 to $200 or more. Typically, Medicare Part B covers 80% of the cost, leaving you responsible for the remaining 20%.

It’s important to note that these shoes and inserts must be acquired from a provider that is Medicare-approved. If you decide to purchase them from a footwear retailer that is not approved, you will bear responsibility for the entire cost.

Remember that when it comes to Medicare coverage for diabetic shoes and inserts, Medicare Part B is the main provider. However, it’s worth mentioning that customized shoes and inserts may be needed during your stay in a skilled nursing home or hospital. In such cases, if the facility provides the shoes and insoles, the cost may be covered by Medicare Part A.

How to get diabetic shoes covered by Medicare?

To be eligible for Medicare coverage of diabetic shoes, individuals must meet the following conditions:

• Diabetes Diagnosis: Individuals must have a diabetes diagnosis to be eligible for Medicare coverage. A physician’s confirmation and verification of the diagnosis is typically required.
• Therapeutic Need: Medicare-covered diabetic shoes are only available when there is a therapeutic need. This means that the shoes must be prescribed by a physician as part of a comprehensive treatment plan for the individual’s diabetes.
• Foot Deformity or Ulceration: Individuals may qualify for coverage if they have a documented foot deformity, such as hammertoes, bunions, or a history of foot ulcers. The presence of a foot ulcer significantly increases the likelihood of qualifying for Medicare-covered diabetic shoes.
• Comprehensive Foot Exam: Before prescribing diabetic shoes, a certified healthcare expert, such as a podiatrist or orthopedic specialist, must have performed a thorough foot examination on the patient. This evaluation aids in determining specific shoe requirements.
• A prescription from a Physician: Regarding Medicare coverage for shoes and inserts, a prescription from a physician or a qualified healthcare practitioner is required. The prescription should state that diabetic shoes are required, as well as any other requirements based on the individual’s foot condition.

Medicare guidelines for diabetic shoes

Each calendar year, the fitting and furnishing of Medicare-approved diabetic shoes and inserts are covered by Medicare Part B. If you have diabetes and severe diabetic foot disease, these will be provided:

• One pair of shoes and insoles that have been custom-molded.
• One pair of extra-depth shoes.

Medicare also covers the following:

• Two extra pairs of inserts for custom-made shoes are available yearly.
• Three pairs of inserts for shoes that have extra depth are available yearly.

Medicare documentation requirements for diabetic shoes

Medicare-covered diabetic shoes come with certain documentation requirements. They are as follows:

• Prescription: Medicare diabetic shoe reimbursement requires a prescription from a trained healthcare expert indicating the medical necessity.
• Detailed Written Order (DWO): The DWO should include details regarding the prescribed shoes, changes, information about the beneficiary, and a signature.
• Proof of Delivery: The supplier must preserve a delivery record, including the date, the name of the beneficiary, and proof of receipt.
• Medical Records: Medicare may require medical data to prove the medical importance of diabetic shoes to the patient.

Working with a Medicare-approved supplier and providing the essential documentation increases the chances of coverage. For assistance in satisfying these requirements, consult a healthcare expert and a supplier.

Conclusion

Diabetic shoes play a crucial role in caring for the feet of people with diabetes, as they help prevent complications and promote better overall well-being. The good news is that there is Medicare coverage for diabetic shoes and inserts. However, it’s important to meet certain criteria and follow the guidelines outlined by Medicare Part B. By having a clear understanding of these coverage requirements and working closely with healthcare professionals; individuals can successfully navigate the Medicare system and access the benefits necessary to maintain healthy feet and effectively manage their diabetes.