Monday, January 18, 2016

Got Diabetes? Learn more about Medicare's Therapeutic Shoe Benefit

If you have foot problems or foot deformities related to diabetes, there is a Medicare benefit that may help you cover the cost of therapeutic shoes. The Medicare Therapeutic Shoe Benefit is available to anyone who has Part B and meets certain requirements.

Your first step is to talk to your primary diabetes doctor about whether or not you need therapeutic shoes. If you doctor agrees, he or she will complete a form that certifies this. In addition, your doctor will provide medical records that show 1) you are being treated for diabetes, and 2) that you meet Medicare’s requirements for therapeutic shoes. This documentation needs to be completed each year.

Once you get a prescription for your footwear, you will be fitted by a podiatrist or other qualified individual, such as a pedorthist, orthotist or prosthetist in order to qualify for this benefit.

Your cost for therapeutic shoes will be 20% of the Medicare-approved amount (after you satisfy your deductible.) Medicare Part B  covers the furnishing and fitting of either one pair of custom-molded shoes and inserts or one pair of extra-depth shoes each calendar year. Medicare also covers 2 (two) additional pairs of inserts each calendar year for custom-molded shoes and 3 (three) pairs of inserts each calendar year for extra-depth shoes. Medicare will cover shoe modifications instead of inserts.

Please be mindful that you must meet three of the following conditions in order to qualify for the Medicare Therapeutic Shoe Benefit:
1.  You have diabetes
2.  You have at least one of the following condition in one or both feet
  -  Partial or complete foot amputation or deformed foot
  -  Past foot ulcer or calluses that could lead to foot ulcers
  -  Nerve damage because of diabetes with signs of problems with calluses
  -  Poor circulation
3. You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.

Be sure to check that your doctor and shoe supplier accept Medicare assignments. This means that they will accept the Medicare-approved amount as payment in full for the shoes, inserts and fitting. Suppliers that do not accept Medicare assignment may charge you more and you could end up paying a bigger portion of the costs.

For answers to more of your insurance questions, visit my website at or call me at 440-255-5700 to set up an appointment to discuss your needs. 

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