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How To Get Diabetic Shoes Through Medicare

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To Find A Supplier/qualified Provider For Your Shoes And Inserts

Pedors Information Video: Medicare Diabetic Shoes

If your treating physician doesnt point you in the right direction, here are some tools to locate qualified providers/suppliers for your shoes and inserts.

To find a Podiatrist you can use the locator tool on the American Podiatric Medical Association website here.

To find a Pedorthist you can use the locator tool on the Pedorthic Footcare Association website here.

To find a Prosthetist you can use the locator tool on the Prosthetist Finder website here.

To find an Orthotist you can use the locator tool on the American Board for Certification in Orthotics, Prosthetics and Pedorthics here.

Obviously, you can use the last locator to find Pedorthists and Prosthetists as well as Orthotists.

Remember to only use Medicare-approved suppliers and those who accept assignment !

So How Do I Get Medicare

You can call 1-800-MEDICARE at any time on any day to ask questions. Users of TTY can call 1-877-486-2048. You will be given a complete list of available plans and someone will be able to discuss your options with you.

Medicare supplement insurance is available if you are already enrolled in Medicare Parts A and B and are over the age of sixty-five. In some states, you may be eligible even if you are under sixty-five because of a disability.

Orthofeet Wichita Stretchy Diabetic Shoes For Women

Orthofeet is the most podiatrist-recommended orthopedic shoe brand for diabetics in the USA. Wichita stretch shoes check all the boxes of the ideal diabetic footwear for women: theyre fully adjustable and absolutely non-binding so they put no pressure points and help boost blood flowing to your lower limbs. The uppers are made with super stretchable material. The closure is a simple hook and loop velcro strap and the tongue completely opens for an easy and pain-free foot insertion.

The interior lining is seamless and foam-padded so youre protected against blisters and skin wounds that could lead to diabetic foot ulcers. The toe box is wider than in regular shoes. It allows you to keep your toes moving to promote blood circulation while preventing toe stubbing. Like every style from Orthofeet, the Wichita Stretch comes in a wide range of widths. On top of that, fitting spacers are included to help you find the perfect fit.

Regarding foot support and stability, these orthopedic shoes are great too! They come with Orthofeets premium orthotic insoles , providing enhanced arch support and excellent cushioning.

If youre concerned about the financial cost of such high-quality diabetic shoes, these are Medicare-approved under code A5500 so they might be covered by your insurance. Last but not least, Orthofeet offers a 60-days wear test and a 100% money-back guarantee.

  • Material: Synthetic
  • Expensive

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Medicare Reimbursement Directly To The Patient

If the local prescribing physician does not accept Medicare assignment, and there is not a local qualified provider that does, the patient has the option of paying the provider the entire amount, and then applying for reimbursement directly from Medicare for 80% of the allowable amount. The Centers for Medicare & Medicaid Services will reimburse 80% of the amount it designates as “allowable, and the patient is responsible for paying 20% of the total payment amount. In order to qualify for coverage the patient must be fitted by a qualified provider, so it is not possible for a patient to purchase footwear directly from a manufacturer or a retail facility or online e-commerce store and then request the 80% reimbursement from Medicare.

NOTE: Some Medicare suppliers may not accept assignment if the allowable amount is too low to cover the appropriate materials and services. In these situations, the total cost to the patient may be higher than the allowable amount. If so, the patient may be expected to pay the Medicare supplier in full before he or she receives reimbursement from Medicare.

Qualifications For Reimbursement For Orthopedic Shoes & Inserts

Diabetic Shoe Clinic on Jan. 25: Register in Advance!
  • You have diabetes and
  • You have one or more of the following conditions:
    • Partial or complete foot amputation
    • Past foot ulcers
    • Nerve damage in your feet with signs of calluses on either foot
    • Deformity of either foot
    • Poor circulation in either foot
  • Your doctor has certified your need in writing stating:
    • You meet the criteria for the shoes
    • The doctor is treating you under a comprehensive plan of care for diabetes
    • The exact reasons you need the therapeutic shoes and/or inserts

    If you meet all the aforementioned conditions there are still other factors that may affect the amount of your reimbursement. Make sure you check with your doctor and plan provider.

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    How Much Coverage Does Medicare Give To Therapeutic Shoes And Inserts For Diabetes

    Typically, Medicare will give 80% coverage to the Medicare-approved cost of therapeutic shoes and inserts for diabetes, leaving you cover the 20% coinsurance of the Medicare-approved cost.

    This is of course if you used all Medicare-enrolled doctors, providers and suppliers, and a supplier who was a Medicare-enrolled participating supplier who accepts assignment.

    On the point of payment, Medicare advices the following

    To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount youll owe may depend on several things, like:

    • Where you get your test, item, or service

    The source of the text is Medicares website page on coverage for therapeutic shoes, which you can read here.

    With regard to the doctors, providers and suppliers for therapeutic shoes, Medicare also writes

    The source of the text is Medicares website page on coverage for therapeutic shoes which you can read here.

    New Balance Medicare Diabetic Sneakers

    New Balance is one of the worlds major footwear manufacturers that distinguishes itself with technical comfort features such as gel inserts, heel counters, foot stability, great cushioning, as well as a wide range of fit, widths, and support options. The company has worked on several styles that qualify under Medicare Code A5500 as therapeutic shoes for diabetics.

    The 813Hv1 sneakers are a great choice for walkers with diabetes. Their iconic Rollbar stability post along with a great rearfoot control provides exceptional foot stability and improved traction. They combine thick supportive foam midsoles as well as great shock-absorbing rubber outsoles.

    The interior of the shoe, the collar, and the leather uppers are smooth and padded to prevent blisters and skin irritations that could lead to infections or diabetic foot ulcers. The adjustable uppers with hook and loop velcro straps allow an easy foot entry and provide a custom fit without having to tie laces.

    These New Balance diabetic shoes are available in narrow, regular, wide, and extra-wide to accommodate every foot type without pressure and stress. Last but not least, theyre durable and great value for money!

    • Material: Leather & Synthetic
    • Non-removable insoles

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    Propt Lifewalker Extra Wide Diabetic Shoes

    Propét has a wide range of high-quality comfortable shoes that qualify as diabetic shoes. If you have wide, very wide, or swollen feet, search no more: Propét shoes are available in 3 to 6 different widths depending on the styles.

    The LifeWalker sneakers for men and the TourWalker ones for women are 100% full-grain leatherwith an incredibly comfortable foam-padded interior. The insoles provide real arch support and are well cushioned. Theyre removable so you can also choose to wear these shoes with your own diabetic insoles.

    The adjustable upper velcro closure makes it easy to find the perfect fit and to readjust your shoes as the day goes by if your feet swell. The rearfoot is well supported with a contoured heel stabilizer.

    Theres enough room for your toes to be protected from stubbing and to keep moving during the day. Plus, the leather exterior provides extra protection from falling objects and toe injuries. These are Medicare-approved diabetic shoes.

    • Material: Leather
    • Not waterproof

    Does Medicare Cover Diabetic Shoes And Inserts

    How to get diabetic shoes from Medicare at no cost to you?

    by Gareth Williams

    I am very lucky in that neither my mom, nor I, suffer from diabetes, although that is not to say that my mom doesnt have the necessary health checks for it. That doesnt mean, though, that you dont need to know for your loved ones, the Medicare coverage, and guidelines, for diabetes, and so I am writing a series of at least three posts to help with that.

    Medicare Part B covers diabetic shoes, inserts and in some cases molded shoes, if you qualify under the Medicare guidelines.

    Firstly, to qualify for shoes and inserts with Medicare Part B

    • you have to have a diagnosis and certification from your physician that you have diabetes this has to be from the physician who is actually personally managing you systemic diabetes condition and that you have diabetes mellitus
    • the/your physician must also certify that you are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes
    • your physician must certify that you have one or more, of a number of foot conditions, in one or both feet

    Note, that your physician who is treating you for diabetes, and giving all the certifications, must be a Medicare-enrolled physician, or you will not qualify for Medicare coverage.

    The document the physician is providing is called a Statement of Certifying Physician, and only the treating physician can complete and then sign this document.

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    How To Get Almost Free Diabetic Shoes Essential Steps You Need To Know

    The American health care system sucks. I can only imagine how hard it must be for someone with a chronic illness such as diabetes. Its bad enough you have to inject yourself with insulin and constantly check your blood sugar and always watch what you eat. For some diabetics, foot problems crop up that require special orthopedic footwear.

    Fortunately, your medical insurance provider might be able to recoup at least some of the cost. You may not even have to pay anything out of pocket! Of course, certain deductibles, co-insurance, and co-payments may apply. Your situation may vary from anothers.

    You will almost certainly require proper documentation from a doctor. Diabetic shoes and inserts are indeed covered under Medicare, Medicaid, and most insurance policies. However, there are certain criteria to be met. Your health care provider must fill out a therapeutic shoe form.

    Typically, if you qualify for the shoes and have met your deductible, Medicare will pay up to eighty percent of the cost. Some secondary insurers may help with the other twenty percent.

    Patient Responsibility For Payment

    Medicare will pay for 80% of the Medicare-approved amount either directly to the patient or by reimbursement after the Part B deductible is met. The patient is responsible for a minimum of 20% of the total payment amount and possibly more if the dispenser does not accept Medicare assignment and if the dispenser’s usual fee is higher than the payment amount.

    Medicare pays only for therapeutic footwear from Medicare-approved suppliers, reimbursing 80% of the cost either to the patient or after the Part B deductible is met. The patient is responsible for the other 20% — or more if the supplier does not “accept assignment” from Medicare. Medicareâs Coverage of Diabetes Supplies & Services.

    The National Institute of Diabetes and Digestive and Kidney Diseases of The National Institutes of Health. Publication: Feet Can Last a Lifetime: Medicare Coverage of Therapeutic Footwear for People with Diabetes. 1998.

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    How To Get Help With Medicare Coverage For Diabetic Shoes

    If you have diabetes and need therapeutic shoes, your doctor can help get you started. When you add Medigap coverage, you can be doubly assured your shoes wont break the bank.

    Your Medigap plan can help with coinsurance, copays, and your Part B deductible. Our agents can help find the best options for you. Call us today for a quote in minutes! Or, if you prefer, you can complete an online rate form, and a member of our team will reach out to you.

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    Just What Makes Diabetic Footwear So Important

    Diabetic Shoe Fitting  Wood River Pharmacy

    Many diabetics suffer from chronic diabetic neuropathy. This is nerve damage that can make your feet vulnerable to injuries in quite a number of various ways. Based on the findings of the Nation Institutes of Health:

    • Injuries can take a longer amount of time to heal properly when there is a restriction in the blood flow.
    • Limbs can sometimes lose feeling. This can make it even more difficult to detect an injury
    • Some patients might lose sensation in their feet. Thus, an injury can go unnoticed and result in an infection

    The Center for Disease Control strongly suggests quarterly foot exams for all diabetic patients. As well as regular exams, the CDC advises patients to keep their feet clean, inspect their feet for injuries, keep their toenails clipped carefully, and wear the proper socks and shoes.

    The National Institutes of Health advocates keeping an open discourse with your doctor concerning your need for special diabetic shoes and/ or shoe inserts. There are quite a number of situations where diabetics might require custom-made shoes that offer additional protection.

    Studies have shown that wearing prescription diabetic footwear can help prevent complications regarding foot health that can often occur due to diabetes. Should you need diabetic shoes, a sort of professional such as a podiatrist, orthotist, pedorthist or prosthetist is required to provide the prescription for therapeutic shoes.

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    Can Medigap Help Cover The Cost Of Diabetic Shoes

    A Medigap policy may be just what you need to help cover your diabetic shoes. Medicare Supplement plans are a great asset in helping with extra costs. Because Medigap plans cover the balance of what Medicare does, Medicare Supplement policies can help cover the out-of-pocket expenses you may have when getting diabetic shoes.

    Great Diabetic Shoes To Protect Your Feet In 2022

    Diabetic shoes play a major role in the foot health of people living with diabetes and neuropathy. Due to higher risks of foot complications, diabetics must take extra care of their feet and be very careful with footwear choices.

    Therapeutic shoes for diabetes are designed by foot experts to prevent and alleviate diabetic foot pain. They promote blood circulation, support the foot, improve traction, protect fragile skin, absorb impacts, and considerably enhance the overall comfort.

    Ive researched and scrutinized dozens of shoes for diabetics to review here 10 of the best ones to protect your feet in 2022.

    • Quick Navigation
    • Expensive

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    How Much Does Medicare Pay For Therapeutic Shoes

    Medicare covers 80% of the cost of diabetic shoes. Private insurances might supplement the remaining 20%. Medicare can pay for one custom pair of folded shoes or one pair of extra-depth shoes per calendar year. You can also be eligible for reimbursement of two extra pairs of diabetic insoles for custom-molded shoes or three pairs of inserts for extra-depth shoes per year. Heres the FAQ about Medicare coverage for diabetic shoes.

    I hope youve find answers to your questions here. Do not hesitate to ask, share, and comment in the section below. What are your favourite diabetic shoes?

    What Type Of Shoes And Inserts Does Medicare Give Coverage To

    Approved by Medicare, Diabetic Shoes

    If you have Medicare Part B and you have met all the Medicare conditions to qualify for shoes and inserts for diabetes,

    The types of shoes that are covered each year include one of these:

    • One pair if depth-inlay shoes and 3 pairs of inserts
    • One pair of custom-molded shoes if you cant wear depth-inlay shoes because of deformity, and 2 additional pairs of inserts

    Note: In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.

    The source of the text is again Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs which you can read or download here.

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    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 To Allow Nurse Practitioners And Physician Assistants To Certify The Medical Need For Diabetic Shoes In Limited Circumstances

    AOPA, in collaboration with other healthcare organizations, has actively supported the inclusion of nurse practitioners and physician assistants to serve as certifying practitioners under the Medicare diabetic shoe benefit. The Social Security Act states that the certifying physician must be the MD or DO that is managing the patients systemic diabetic condition. This has led to significant access issues as the delivery of healthcare has evolved and non-physician practitioners have become more prevalent as primary care providers.

    The Durable Medical Equipment Medicare Administrative Contractors recently announced two separate pathways that expand the ability of NPs and PAs to certify the medical need for diabetic shoes provided to Medicare beneficiaries.

    The first pathway only applies to NPs and is being coordinated by the Center for Medicare and Medicaid Innovation through the Primary Care First demonstration project. The PCF demonstration project will be implemented on January 1, 2021 and will run through December 31, 2025. NPs that are participating in the PCF demonstration project in one of the 26 states/regions that it will be implemented in may serve as the certifying practitioner for diabetic shoes covered by Medicare. The PCF model does not require the NP to operate under the direct supervision of a physician, but it does not apply to physician assistants. The announcement of the expansion of the role of NPs under the PCF demonstration project may be viewed HERE.

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