Medicare beneficiaries can rest easy knowing that medically necessary podiatry services are available and covered for those who need podiatry care. Podiatrists can help beneficiaries with conditions like arthritis, diabetes, and more. Below we’ll review Medicare’s coverage of podiatry services and your coverage options.
Medicare coverage for podiatry services
Medicare Part B will cover podiatry services and care for certain necessary conditions. Some of the most common conditions that could warrant a trip to a podiatrist include nerve damage caused by diabetes, treatment for an injury to your foot, or certain diseases like heel spurs. With Part B coverage, you’ll need to meet your annual deductible.
Once you meet your deductible, you’ll pay a 20 percent coinsurance, and Medicare will pay 80 percent of the treatment costs. In addition to your deductible and coinsurance costs, you’ll pay a monthly Part B premium of $164.90.
Some of the most common conditions that beneficiaries visit podiatrists for include:
- Bunion deformities
- Heel spurs
- Fungal nails
- Plantar warts
- Hammer toes
Part B will cover exams every six months with a podiatrist if you have any of the following health issues:
- Diabetic neuropathy
- Protective sensation loss
Medicare Advantage plans and podiatry
Medicare Advantage policies are required to cover, at the bare minimum, at least what Original Medicare covers. When using a Medicare Advantage plan, you’ll want to find a podiatrist who’s in-network with your specific plan. If you visit an out-of-network podiatrist, you’ll likely pay significant amounts out-of-pocket.
Another thing you’ll need to do is to make sure precisely of what your specific plan covers in detail. Doing this can eliminate potential insurance coverage headaches that can develop down the line. Remember that you’ll also need a referral from your regular doctor to see a specialist podiatrist.
Medicare Supplement coverage for podiatry coverage
Medigap plans significantly help save money. Medicare Supplement plans will help bridge the gap between your Original Medicare and out-of-pocket expenses. For instance, if you’re left with a $350 out-of-pocket bill after your Part B coinsurance kicks in, your Medigap policy will help with this out-of-pocket bill. Medigap policy premiums can vary depending on your carrier and your specific plan’s coverage. Medigap is the perfect option for those who face significant medical bills.
Will Medicare pay for foot problems?
Medicare will pay for various foot problems for Medicare beneficiaries. Some health conditions can lead to foot deterioration, such as nerve damage caused by diabetic neuropathy. When someone loses sensation in their foot, the risk of a more severe injury can be prevalent. If not correctly cared for, diabetic neuropathy can lead to foot amputation.
So, having health coverage for severe conditions is crucial. Medicare will cover all medically necessary medical conditions of the foot with a podiatrist. If you end up in a hospital, Medicare Part A will cover your inpatient hospital stay for services you receive, if medically necessary. If your podiatrist decides you need surgery to correct your foot issues, Part A could also cover that.
Podiatry services covered by Medicare
Since Medicare Part B covers medically necessary conditions of the feet, knowing what type of conditions may qualify and which services Medicare will pay for is essential. Some of the most common podiatry services that Medicare will cover for beneficiaries include:
- Prosthetic devices like ankle braces
- Custom therapeutic shoes or shoe inserts
- Toenail fungus treatments like debridement
- Surgical procedures for hammertoe
- Bunion treatments like toe spacers
Medicare covers footwear and inserts to help relieve pain and treat conditions involving the feet. It is important to note that coverage is only available if prescribed by a doctor and the footwear and inserts are medically necessary.
Medicare covers both diabetic and therapeutic shoes, as well as inserts, designed to reduce pain and prevent further injury to the feet. Properly fitting shoes and inserts are essential to providing adequate support and comfort to improve mobility and reduce pain.
Any questions regarding Medicare coverage of shoes and inserts should be discussed with a doctor or Medicare representative.
Medicare will cover the cost of orthopedic shoes if your doctor participates in the program and the shoes are deemed medically necessary as a part of leg braces. Your physician must prescribe leg braces and orthopedic shoes as a pair to help you maintain mobility; standalone orthopedic shoes will not qualify for reimbursement.
For orthopedic shoe prescriptions that meet the criteria, your orthopedic specialist and the supplier must participate in the Medicare program to avoid any fees beyond the coinsurance and Medicare Part B deductible. Suppliers not accepting Medicare assignments may charge any price for orthopedic shoes.
Therapeutic shoes and inserts
If you have diabetes and severe diabetic foot disease, Medicare provides annual coverage of one pair of custom-molded shoes and inserts, plus one pair of extra-depth shoes. Furthermore, Medicare provides a yearly allowance of two extra inserts for custom-molded shoes and three pairs of inserts for extra-depth shoes. In lieu of inserts, Medicare also covers shoe modifications.
Foot procedures that Medicare won’t cover
While Medicare covers quite a bit if medically necessary, Medicare won’t cover all foot procedures with podiatrists. Some of those procedures that you’ll need to pay entirely out-of-pocket for include:
- Treatments for flat foot
- Corn removal
- Callus removal
- Foot cleaning
How often does Medicare approve toenails to be cut?
Medicare will cover toenail cutting with a podiatrist. Beneficiaries can schedule a toenail cutting every 61 days as long as they meet Medicare requirements for toenail cutting. You must have a health condition that deems this service necessary, as Medicare won’t cover toenail cutting for healthy people. Some health conditions warranting this service include:
- Peripheral neuropathy
- Chronic phlebitis
- Peripheral arterial disease
Medicare coverage for toenail removal
Ingrown toenails can be incredibly painful and lead to further problems if severe enough. Medicare Part B will pay for toenail removal if necessary. Ingrown toenails can become severe enough that removal of the nail is required so that proper healing can occur. Your podiatrist will likely try various treatments and procedures before moving onward toward surgery. But, if your podiatrist finds it necessary, Medicare will cover the toenail removal at 80 percent.
Again, you’ll need to cover a 20 percent coinsurance cost and ensure you pay your annual deductible and monthly premiums. Should you require a toenail removal while staying in the hospital, your Part A benefits will cover the removal if medically necessary. Your deductible is $1,600 per benefit period in 2023. Toenail removal procedures generally cost between $200 and $500, so the out-of-pocket cost you’d be responsible for will be significantly less.
Does Medicare cover podiatry for plantar fasciitis
Medicare will cover podiatry for plantar fasciitis if you meet all necessary Medicare requirements. Again, this condition must be deemed medically necessary to be covered. This condition can make it incredibly difficult to walk and is incredibly painful if left untreated. Medicare Part B will cover the outpatient treatments for your plantar fasciitis. You’ll be responsible for 20 percent of the treatment costs.
Medicare-covered podiatry services for neuropathy
Diabetic neuropathy is the result of nerve damage to the feet. Diabetic neuropathy can lead to severe injuries if left untreated, such as infections and, sometimes, amputation. Original Medicare (Part A and Part B) will contribute towards podiatry appointments to help treat neuropathy, as long as you meet the medical requirements with Medicare.
Does Medicare cover bunion surgery?
If your podiatrist finds it medically necessary to remove a bunion, Original Medicare will pick up the surgery costs. Before your podiatrist agrees to surgery, they will try various treatments, like pads or inserts for your shoes. Usually, bunion removal surgery costs between $3,500 – $12,000.
Does Medicare cover hammertoe surgery?
Hammertoe is a disease that causes intense pain and can worsen if untreated. Original Medicare will cover the cost of hammertoe surgery if medically necessary. Your podiatrist may decide this route is needed if you develop issues with your balance or uncontrollable pain. Hammertoe surgeries cost around $9,000 if you don’t have health insurance.
What’s the Medicare cost of routine podiatry services?
Routine podiatry services fall under Medicare Part B. Once your annual Part B deductible is met, you can expect to pay 20% of the bill and any associated excess charges. If enrolled in a Medicare Supplement or Medicare Advantage plan, your costs would vary depending on your chosen plan.
Need help understanding your Medicare plan’s coverage of podiatry?
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