The human foot has 26 bones and 33 joints, making them a complicated area of the body. Osteoarthritis, diabetes, and bunions are just some of the foot-related issues someone can encounter throughout their lifetime. Foot pain is also common in older adults and can cause limited mobility and other issues over time if it goes untreated.
A podiatrist can help with a variety of foot-related issues, but will Medicare cover you seeing a podiatrist? What foot care health services and treatments will Medicare also cover?
Will Medicare cover seeing a podiatrist?
Medicare may or may not pay for you to see a podiatrist. It depends on (1) what foot care services you see a podiatrist for, and (2) what kind of Medicare coverage you have.
Medicare Part B covers some podiatry care if you have a need that is medically necessary, such as diabetes-related nerve damage or the treatment of foot injuries or diseases. It may also cover therapeutic shoes and inserts (or even shoe modifications) that a podiatrist recommends if you have diabetes and suffer from severe diabetic foot disease.
If you have a Medicare Advantage (Part C) plan, your coverage and costs may be different. Talk with your plan provider, but you may be able to get more foot care benefits than with just Medicare Part B.
Will Medicare cover routine foot care?
Medicare Part B doesn’t typically cover routine foot care, such as cutting or removal of corns and calluses, trimming of nails, or other hygienic maintenance, such as cleaning or soaking of the feet. If you see a podiatrist or other healthcare specialist for routine foot care, you’ll generally need to pay 100 percent of the costs.
You may be able to get routine foot care covered if you have a Medicare Advantage plan, but again, you’ll need to check with your plan provider first.
What foot care services will Medicare cover?
Annual foot exams or treatments may be covered by Medicare Part B if you have diabetes-related nerve damage or need medically necessary treatments for a related foot injury or disease. Medicare Part B may cover medically necessary treatments for injuries or disease such as hammer toe, bunion deformities, and heel spurs.
You will pay 20 percent of the Medicare-approved amount for the medically necessary treatment, and the Part B deductible will apply. However, for the treatment to be covered by Medicare Part B, you will also need a referral from your doctor. The amount you pay will be determined by whether your doctor accepts Medicare assignment. The amount you pay may also change based on other insurance you may have, how much your doctor charges, and the type of facility used for your treatments and testing. For example, in a hospital outpatient setting, you may also pay a copayment for medically necessary treatment.
Again, your costs and coverage may be different with a Medicare Advantage plan, but when it comes to Medicare Part B, if your foot care treatment isn’t medically necessary and/or you do not receive a doctor’s referral, you will generally have to pay 100 percent of the costs.
How does Medicare cover diabetic foot care?
As noted above, Medicare Part B covers yearly foot exams or treatments if you have diabetes-related nerve damage . More specifically, Medicare will cover an annual foot exam if you have “diabetes-related lower leg nerve damage that can increase the risk of limb loss” and “you haven’t seen a footcare professional for another reason between visits.”
In general, Part B will cover 80 percent of the Medicare-approved amount, the Part B deductible applies, and if services are provided in a hospital outpatient setting, a copay may also apply. If you have other insurance or a Medicare Advantage plan, your costs may be different.
See below for some things Medicare may cover if you qualify, and if your doctor and the shoe or insert supplier are enrolled in Medicare.
A pair of custom-molded shoes and inserts
A pair of extra-depth shoes
Two additional pairs of inserts each calendar year (for custom-molded shoes)
Three additional pairs of inserts each calendar year (for extra-depth shoes)
Shoe modifications (if you don't use inserts)
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