Medicare Part B Could Help You Save a LimbPosted by Medicare Made Clear
Do you have diabetes? Have you had foot problems related to diabetes, such as loss of feeling, wounds that won’t heal or troublesome calluses? If so, there’s a Medicare benefit that may help you.
Medicare Part B covers therapeutic shoes if you have diabetes and meet certain requirements. Therapeutic shoes may help prevent foot ulcers and other foot problems. This is important because an infected, slow-to-heal foot ulcer can lead to bone infection. And bone infection can lead to amputation.
Who Can Get Therapeutic Shoes?
You may qualify for therapeutic shoes if you meet the following three conditions:
1. You have diabetes.
2. You have at least one of the following conditions in one or both feet:
a. Partial or complete foot amputation
b. Past foot ulcers
c. Calluses that could lead to foot ulcers
d. Nerve damage because of diabetes with signs of problems with calluses
e. Poor circulation
f. Deformed foot
3. You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.
Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year. You can get:
One pair of off-the-shelf extra-depth shoes and three additional pairs of special inserts. Extra-depth shoes have room to accommodate innersoles or orthotics.
One pair of off-the-shelf extra-depth shoes including a modification, and two additional pairs of inserts.
One pair of custom-molded shoes and two additional pairs of special inserts.
How to Get Therapeutic Shoes
The Medicare Therapeutic Shoe Benefit is available to anyone who has Part B and meets the requirements. Your primary diabetes doctor must complete a form that certifies that you need therapeutic shoes. In addition, your doctor needs to ensure that your medical record shows that 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.
You need a prescription for therapeutic shoes from a podiatrist or physician trained to fit shoes and inserts for people with diabetes. The prescription will indicate the particular type of footwear you need.
Your footwear must be furnished and fitted by a podiatrist or other qualified individual, such as a pedorthist, orthotist or prosthetist. Your primary physician may furnish the footwear if he or she practices in a defined rural area or in an area where there is a shortage of health professionals.
What Will You Pay?
Your cost for therapeutic shoes is 20% of the Medicare-approved amount after the Part B deductible. You need to ensure that the shoe supplier accepts Medicare assignment. This means that the supplier accepts 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. You may end up paying more or even having to pay the full cost (your share plus Medicare’s share).
Diabetes Foot Care
Foot care is an important part of diabetes care. Remember to check your bare feet every day. Look for red spots, cuts, swelling and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help. Call your doctor if you find anything that concerns you.
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
Medicare’s Coverage of Diabetes Supplies & Services: Learn what’s covered and what’s not in this Medicare publication.
Diabetes Foot Care: Get tips on caring for your feet from the American Diabetes Association.
Medicare.gov: Visit the official U.S. government site for Medicare.
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