Tendonitis, ankle sprains, and hip pain are just a few examples of foot problems that make everyday movement difficult. 

Fortunately, custom foot orthotics are available to ease the discomfort. But they are not very affordable. 

A custom orthotic for shoes typically costs $300 to $800. If you go for a semi-custom, the prices vary between $100 to $300. The only affordable option is the premade insole available at the drugstore for $20, which is practically good for nothing. 

This might have made you question; Are orthotics covered by Medicare? 

Well, in this article, we discuss whether there is any Medicare orthotics coverage as well as what is the amount paid. 

Does Medicare cover custom orthotics?

Yes, Medicare can cover custom orthotics in certain situations. If a doctor prescribes custom orthotics as a medically necessary item to treat a specific foot condition, Medicare Part B might provide coverage. 

However, it’s important to meet Medicare’s requirements, such as having a doctor’s prescription and using a supplier that is enrolled in Medicare. 

Standard orthotics that you can buy without a prescription are usually not covered. It’s recommended to check with Medicare or your healthcare provider to understand the details of coverage for custom orthotics in your situation.

How much will Medicare pay for custom orthotics?

Being eligible for custom orthotics Medicare doesn’t mean you won’t have to pay anything. The government healthcare program is designed to make medical services accessible and affordable for seniors – but not completely free.

So, despite your foot condition, you must pay your Medicare Part B deductible and a co-payment of 20%. If you have already paid the deductible for the year, you will only pay 20% of the orthotic cost and Medicare will cover the remaining amount.

To understand this better, let’s have a look at this example.

“Joshua is enrolled in Original Medicare. Medicare Part B has a yearly deductible of $240 (as of 2024). His doctor recommended the use of orthopedic shoes to ease his diabetes pain. The total cost for the custom-made orthopedic shoes will be $650.” 

Here’s what he will pay based on the deductible payment:

Part B Deductible for 2024	Joshua Pays	Medicare Pays
Deductible Already Paid	$130 (20% copayment only)	$520
Deductible Not Paid	$240 + $130 = $370 (deductible + copayment)	$280

Please note the deductible amount changes every year. It was $226 in 2023, whereas it is $240 in 2024. This is a $14 increase in the annual deductible!

Medicare guidelines for orthotics and prosthetics

Medicare covers orthotics and prosthetics when they’re considered medically necessary and prescribed by a doctor. Here are the key points:

• Doctor’s prescription: A doctor must prescribe an orthotic or prosthetic device for your specific medical condition.
• Supplier enrollment: The supplier providing the device needs to be enrolled in Medicare. 
• Documentation: The doctor and supplier must document the medical need and submit it to Medicare.
• Coverage criteria: Orthotics and prosthetics that fall under the Durable Medical Equipment (DME) will be covered by Medicare if medically necessary and prescribed by a professional. 

However, please note that orthopedic shoes and inserts aren’t considered DME. Their cost will only be covered by Medicare if you have diabetes or severe diabetic foot disease (more on this later!). 

Since not all prosthetics and orthotics are covered by Medicare, it’s essential to check with the service provider. This will help ensure you meet the guidelines for coverage. 

Does Medicare cover orthotics for plantar fasciitis?

Plantar fasciitis is a common foot condition characterized by pain in the heel and bottom of the foot. It occurs when the plantar fascia, a band of tissue connecting the heel bone to the toes, becomes inflamed or strained.

It often causes sharp, stabbing pain – especially during the first steps in the morning or after prolonged rest. Most podiatrists typically prescribe steroid injections, physical therapy, or surgery.

Orthotics aren’t necessary to treat this condition, so Medicare typically does not cover the cost. However, if your doctor prescribes orthotics as the only suitable treatment for plantar fasciitis, Medicare may cover it. 

Does Medicare cover orthotics for flat feet?

Flat feet, also known as fallen arches, occur when the arches on the inside of the feet are lower than usual. This can cause the entire sole to touch the ground when standing. It might lead to discomfort or pain in the feet, ankles, or legs for some people.

Most people outgrow this condition through physical therapy, insoles, and surgery. Since insoles are not the only treatment for flat feet and are not medically necessary, Medicare coverage does not usually include them. But if your doctor proves it to be necessary, you might get coverage.

Does Medicare cover orthotics for diabetics?

Yes, Medicare covers orthotics for diabetics. This is because foot conditions related to diabetes, such as neuropathy and ulcers, can be life-threatening. The use of orthotics is considered medically necessary. 

In one calendar year, Medicare orthotics coverage includes:

• A pair of custom-made shoes and inserts with 2 pairs of inserts
• A pair of extra-depth shoes with 3 pairs of inserts

Most inserts are very durable and will last more than 1 year. But if for some reason you use up all 2 or 3 pairs of inserts, Medicare won’t pay for the extras. 

Does Medicare Advantage cover orthotics?

Medicare Advantage plans (also called Part C) are offered by private insurance companies approved by Medicare. They combine the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan. 

So, yes, Medicare Advantage covers orthotics. But, since most insurance providers set their own rules and costs, you should confirm it with relevant company representatives. 

Article updated on January 16, 2024.