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How Do I Get Medicare Diabetic Shoes

Updated on February 10, 2014
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Medicare Diabetic Shoes

In the United States, prescription diabetic shoes are covered by Medicare if the proper requirements are met. For people that have diabetes and require diabetic footwear for medical reasons, Medicare will cover the cost of one pair of diabetic shoes and three diabetic inserts (up to 80%) per calendar year.

People that are eligible for this coverage must have diabetes and severe diabetic foot diseases, however a doctor must certify that a patient needs therapeutic shoes and inserts. In order to have Medicare cover the cost of diabetic shoes, a podiatrist or any other qualified doctor must prescribe these items and they must be provided by any one of the following:

  • podiatrist
  • orthotist
  • prosthetist
  • pedorthist

Funny Video for Medicare Diabetic Shoes

PW Minor Foreman Diabetic Approved Boots (HCPCS A5500)

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How to Qualify for Medicare Diabetic Shoes

In order to qualify for Medicare covered diabetic shoes and diabetic insoles, a podiatrist must prescribe the items and the prescription must be filled by any of the specific health professionals as mentioned above. The prescribing doctor must complete a certificate of medical necessity for diabetic shoes and it must be documented in the patient's medical records.

In order to qualify for the coverage of diabetic shoes, patients must be covered under Medicare Part B and meet all three of the following conditions:

1) Patient has diabetes

2) Patient has at least one of the following conditions:

  • Partial or complete foot amputation
  • Foot ulcers
  • Calluses on either foot which can lead to ulcers
  • Nerve damage in feet w/ signs of calluses on either foot
  • Foot deformities such as hammertoes or bunions
  • Poor circulation in the feet

3) Patient's doctor certifies in writing stating that:

  • The aforementioned requirements are met for diabetic shoes
  • Patient's certifying physcician (MD or DO) is treating them for diabetes under a comprehensive plan of care
  • Specific reasons why patient needs diabetic shoes and/or inserts

Medicare does not offer coverage for diabetic shoes if all three of these requirements are not met.

How Much Will Medicare Diabetic Shoes Cost Me

Diabetic shoes are not free, however Medicare does cover 80% of the cost of the shoes and the must pay for the remaining 20%. If a patient choose to buy from a supplier who accepts assignment, they will most likely pay less.

Terms

medicare assignment - a doctor or hospital that has accepted Medicare patients and has agreed not to charge them more than what is approved by Medicare

Limitations of Medicare Diabetic Shoes

In order to qualify for diabetic shoes that are covered by Medicare, the diabetic patient must meet the above mentioned requirements. Even after the before mentioned requirements are met, there are still limitations on to what Medicare will cover. Below is a list of items that are covered by medicare:

  • 1 pair of off-the-shelf depth shoes w/ 3 additional pairs of multi-density inserts
  • 1 pair of off-the-shelf depth shoes, modification of the shoes and 2 additional pairs of multi-density inserts
  • 1 pair of custom-molded shoes and 2 additional pairs of multi-density inserts

Where Do I Get My Diabetic Shoes

  • In order to receive diabetic shoes, the prescribed patient must be fitted for diabetic shoes by a podiatrist or any other qualified individual.
  • The certifying physician is not allowed to provide the patient with the footwear, unless they practice in a defined rural area or there is a shortage of health professionals
  • The prescribing physician may be the supplier.

Medicare Covered Diabetic Shoes or Online Retailers?

Although the Medicare program does cover some of the cost of diabetic shoes (up to 80%), the patient is still required to pay for their shoes out of pocket. The disadvantage of purchasing Medicare diabetic shoes is that doctors and physicians often charge exorbitant prices for the shoes and inserts that are much higher than if the items were bought out of pocket from a retailer.

Diabetic shoes typically retail anywhere from $100-$160 for a good quality pair, however the prescribing physician will charge Medicare up to four times that amount with the bill coming out to upwards of $500. Medicare will cover 80% of the charge but you will still be responsible for covering the other 20% which is $100.

Online retailers have seen the growing need for diabetic footwear and have began to expand their product selection to better suit diabetic patients. Many online retailers offer excellent diabetic shoes that are the same ones supplied by the prescribing physician at the retail price. If additional shoes are needed, online retailers are another great option to think about.

Medicare or Online Retailers

Would you rather buy diabetic shoes through Medicare or online retailers

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    • profile image

      Doug Hayes 17 months ago

      rtsmith: People pay a lifetime of payroll taxes so they can get Medicare when they retire. Diabetic shoes can cost up to thousands of dollars out of pocket. You're atrocious.

    • profile image

      rtsmith 22 months ago

      sammy tanner: you are not being denied proper health care. You just want uncle sam to pay for it. You can pay out of your pocket and get the shoes you need.

    • profile image

      sammy tanner 2 years ago

      Medicare has ask for so much of paper work that my doctor will not do the paper work. so i can not get diabetic shoes. i have calluses that is sore and i have nerve damage. i am being denied proper health care

    • profile image

      MrsFoot 3 years ago

      The above article is factually incorrect. If Medicare allowable is only $ x, the doctor can charge whatever he wants and can only get paid what Medicare allows. The patient is only respsonsible for the 20% of Medicare's ALLOWABLE charge. There is a lot to be said by getting your diabetic shoes and insoles from a qualified professional who can ensure that the shoes and insoles are truly providing the protection needed by the diabetic patient with ulcers/deformity or neuropathy.

    • bigfeet profile image
      Author

      Marcus 3 years ago from California

      Hi Mary,

      You would need to go to your primary care physician who helps you with your diabetes to see if you meet the specific requirements. If you do, a prescription will be provided for you so that you can go to a pedorthist to have your foot fitted and they can also order shoes for you and bill insurance.

    • profile image

      Mary Haugen 3 years ago

      Who do I contact to get help?

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