It’s said that nearly 90 percent of Americans will experience foot pain within their lifetime.
About one-third of people, 65 and older admit to having either stiffness or aches and pains in
their feet.
Some of the most common foot disorders in seniors are bunions, calluses and corns, and
toenail conditions. Painful foot conditions can lead to mobility difficulties, which in turn can
lead to poor overall health.
Because we use our feet to walk, stand, balance, climb stairs, and do other daily activities, it’s
important we take care of them. Who better to see for foot pain than a foot specialist? But
Medicare doesn’t cover all podiatry services.
How Medicare Pays for Podiatry
First, let’s talk about which part of Medicare offers coverage for podiatry services. Because
podiatry is a doctor service usually done in an outpatient setting, Medicare Part B dictates
coverage.
Part B covers medically necessary outpatient services such as doctor services, lab testing, and
chemotherapy. When accessing Part B coverage, you must first meet your Part B annual
deductible. As of 2019, that deductible is $185.
Medicare Part B will pay the majority of your medically necessary outpatient bills at 80 percent.
You will be responsible for the rest unless you have a Medigap plan such as Plan G. Medigap
Plan G covers all of your cost-sharing expenses within Original Medicare but one – your Part B
deductible.
Plan G also covers your Part B excess charges. An excess charge is an up to 15 percent
additional balance on your bill. You incur an excess charge when you see a doctor who doesn’t
accept Medicare assignment. If you don’t have a Medigap plan that covers these excess
charges, be sure to always see providers who accept Medicare assignment.
If you are enrolled in a Medicare Advantage plan instead of Original Medicare, you will still have
access to all the same covered services as Medicare. However, your copay responsibility may be
different so you will want to consult your plan documents to estimate your cost-sharing.
Routine Foot Care is Almost Never Covered
Routine foot care persists of regular hygienic maintenance such as trimming nails and applying
foot cream. Medicare only covers medically necessary services, which these are not. However,
if you have another underlying health condition that affects your feet, Medicare may cover
them.
For example, if you suffer from a systemic condition, such as high blood pressure or diabetes,
that cause circulatory issues in your legs and feet, Part B may cover routine foot treatments
such as corn removal and nail debridement.
Diabetes Patients’ Special Benefits
Because diabetes can cause many foot issues, Medicare will cover extra podiatry services for
beneficiaries who have a confirmed diabetes diagnosis. Medicare will cover a routine foot exam
every six months if you have been diagnosed with diabetes.
However, you can’t have gone to the podiatrist in the meantime for any other reason. For
instance, if you see a podiatrist during the month of May for a Medicare-covered service and
are scheduled for your diabetic foot exam in June, you will have to reschedule your exam for six
months after May.
Medicare will also cover therapeutic shoes and inserts for diabetes patients. There are two
types of therapeutic shoes in this benefit – custom-molded shoes and depth shoes. These shoes
and inserts are billed as durable medical equipment (DME) under Part B. Under this benefit, the
beneficiary is limited to one pair of shoes per year.
To ensure your DME is covered under Part B, your doctor will need to successfully document
the following:
Your diabetes diagnosis
You’re being treated for diabetes
You have at least one type of foot condition
Once the certification for therapeutic shoes has been created, your doctor should send you to a
DME supplier to fill your prescription.
In the end, if you can determine whether your podiatry service is medically necessary, you
should be able to figure out whether Medicare will cover it.
