Did You Know That Medicare Can Help Pay For Specialty Orthotics?

• Author: Monica Jackson
• Posted: 2024-06-10

It's no secret that getting older comes with a lot of issues; budgets can often be tight, medical issues develop, and getting around can be a lot harder. One particular problem, which is often exacerbated by existing medical conditions, is foot pain. Foot pain can sometimes be excruciating and limit mobility considerably, but fortunately it's possible to negate the effects of discomfort through getting custom-fit shoes.

While custom orthotics can get pretty pricey, you don't need to pay for them completely out of pocket as much of the cost can actually be covered by Medicare Part B.

What Exactly Is Medicare Part B?

Medicare Part B is a completely optional subset of Medicare insurance that deals with outpatient services, vaccines, screenings, and various forms of preventative care. Part B tends to cover services and supplies that most people might not need as part of their routine medical care, but might want to take advantage of if they have some sort of chronic condition.

Part B requires participants to pay an additional monthly premium and is considered to be supplementary to Medicare Part A, which covers the most basic medical services like hospital stays and nursing care.

Why Does Medicare Pay For Custom Orthotics?

Although foot pain can be debilitating, Medicare Part B doesn't necessarily cover orthotics in all instances. The presence of things such as plantar fasciitis, arthritis, abnormally formed arches, and hammertoes can cause significant difficulties when walking or even result in back pain in certain cases; however, pain or discomfort alone isn't enough for Medicare to cover orthotic devices.

In accordance with the Therapeutic Shoe Bill (TSB) passed in 1993, people enrolled in Medicare Part B are annually allowed a single pair of custom-fit shoes as well as three custom-fit insoles. It should be noted though, that this allotment comes with some caveats.

To begin with, the use of specialty orthotic devices has to be deemed 'medically necessary' by a medical professional. While there are potentially many conditions which require the use of specialty orthotics, typically they're used to alleviate problems associated with diabetes, a relatively common condition among older individuals. In order for a diabetic patient to qualify for subsidized orthotics, their condition must meet at least three of the following criteria:

• Diabetes complications are causing nerve damage


• Diabetes is resulting in foot deformities


• Foot ulcers are common


• Circulation issues are causing foot damage

Assuming enough criteria are met, specialty orthotic assistance can be green-lighted by a doctor, preferably a podiatrist, as it's deemed to be an important facet of an individual's healthcare.

How Is Everything Paid For?

While it's entirely possible for you to receive financial assistance for orthotics, you'll only be able to qualify if you seek out a qualified medicare supplier. Be sure to ask your primary physician or specialist about places you can go to purchase your prescription orthotics. Suppliers that aren't in Medicare whatsoever not only won't qualify for orthotic coverage under Medicare Part B, but will also be able to charge whatever rates they want since there's no oversight dictating how much they're able to bill their customers.

Among suppliers who are enrolled in Medicare, some might not be 'participating,' meaning that they do accept medicare as a form of insurance, but still reserve the right to deny offering their services to those who are interested in them; participating suppliers are obligated to accept orthotics requests. Purchasing orthotics from an enrolled supplier will limit your orthotics cost considerably, costing anywhere from $50 to $200 on average as opposed to potentially hundreds more from a non-enrolled one.

When purchasing your custom orthotics, Medicare will cover roughly 80% of the cost, with the remaining 20% and copay being the only thing you have to pay out of pocket.

Taking Advantage of The Program

There are all sorts of hidden benefits associated with Medicare coverage that most people don't know about. If you're diabetic and are looking for ways to keep your nerve pain or limb issues at bay, then it's a really good idea to take advantage of orthotics coverage offered under Medicare Part B. Having life-altering medical conditions is hard enough as is, so it's important to get some respite whenever possible.