Does Medicare Cover Orthotics?
If you are experiencing foot, ankle, or back pain, your health care provider may suggest wearing an orthotic to treat or correct a physical problem that is causing your discomfort. Physicians often prescribe orthotics to treat many medical conditions such as the following:
- Osteoarthritis and rheumatoid arthritis that cause foot discomfort or abnormal bone positioning
- Back pain that is caused by abnormal foot positioning
- Bunions that are causing foot deformities
- Bursitis which is inflammation of the heel or toe
- Diabetic neuropathy
- Flat feet
- Hammer toes
- Heel spurs
- High arches
- Foot and/or ankle trauma
- Plantar fasciitis
Your physician may also suggest wearing an orthotic after undergoing hip or knee replacement surgery to aid your healing process.
If your doctor prescribes an orthotic, you can get either a custom-made one or a pre-made device that fits your need. Depending on the type you get, the cost can vary greatly, but your Medicare coverage may help you pay for a portion of this expense.
How does Medicare pay for orthotics?
If your health care provider or physician prescribes a custom-made or pre-made orthotic device for you because you have a qualifying condition and the device(s) are deemed medically necessary to treat your condition, your Medicare insurance may cover its share of the cost.
Original Medicare Part B (medical insurance) covers orthotics that are categorized as durable medical equipment. If you have severe foot disease or diabetes, you can get the following orthotics on a yearly basis:
- One pair of custom-fit shoes
- One pair of custom-fit inserts
- One pair of shoes with extra depth
- Two additional pairs of inserts for custom shoes
- Three additional pairs of inserts for extra-depth shoes
- Modification of custom shoes rather than inserts
Original Medicare Part B also covers the following orthotic devices under durable medical equipment for beneficiaries who qualify:
- Braces for ankles, feet, knees, back, neck, spine, hands, wrists, and elbows
- Orthopedic shoes that are part of a leg brace
- Prosthetics such as artificial limbs
To be eligible for coverage, you must meet all the following criteria:
- Orthotics must be medically necessary and part of your complete treatment.
- The prescribing physician must accept Medicare assignment
- The durable medical equipment supplier must accept Medicare assignment
Original Medicare Part B pays for 80 percent of the final approved amount of your orthotic(s). You pay the remaining 20 percent after paying your annual Part B deductible.
Without insurance coverage, a pair of custom-molded shoes and inserts can cost several hundreds of dollars. It’s difficult to estimate how much a pair of shoes and inserts would cost, but the national average cost is between $200.00 and $800.00 per pair.