Living with diabetes is no small feat, and managing it effectively means paying extra attention to your foot health. Complications like foot ulcers or infections can develop quickly and lead to significant health risks. That’s why diabetic shoes aren’t just a nice-to-have for people with diabetes – they can be essential. You may be wondering, “Does Medicare help cover this cost?” The short answer is yes, but there are specific guidelines you need to follow to qualify.
This guide will walk you through everything you need to know about Medicare coverage for diabetic shoes, the importance of protecting your feet, what you’re entitled to under Medicare, and actionable steps for accessing these benefits. Plus, learn how the Mair Agency can help you make the most of your Medicare plan.
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Will Medicare Cover Shoes for Diabetics?
Yes, Medicare can cover extra-depth shoes and inserts for individuals with diabetes under certain conditions. These shoes are designed to reduce the risk of foot complications such as ulcers and infections, which are common among people with diabetes.
According to MedicareFAQ, Medicare Part B covers therapeutic shoes for diabetics if they are prescribed by a doctor who is enrolled in Medicare. To qualify for coverage, you must have diabetes and one or more of the following conditions:
- Previous foot ulceration
- Pre-ulcerative calluses
- Peripheral neuropathy with evidence of callus formation
- Foot deformity
- Poor circulation
What Are the Criteria for Diabetic Shoes?
To qualify for Medicare coverage of diabetic shoes, your doctor must certify that you have diabetes and that the shoes are necessary for your treatment. The shoes must also be prescribed by a Medicare-enrolled doctor or podiatrist.
According to Medicare.gov, Medicare covers one pair of extra-depth shoes per calendar year for individuals with diabetes who qualify under the conditions mentioned above. Additionally, Medicare covers three pairs of inserts each calendar year.
What Makes Diabetic Shoes Special?
Unlike regular sneakers or casual footwear, diabetic shoes include features that can make a big difference in your foot health:
- Extra depth and roomy toe boxes: To alleviate pressure on sensitive areas and accommodate custom inserts.
- Seamless, soft interiors: To prevent irritation or rubbing that might cause blisters or sores.
- Firm, cushioned soles: These reduce impact and support proper foot alignment.
- Adjustable closures: Velcro straps or stretchy laces ensure you can adjust the fit to avoid tightness or discomfort.
- Breathable materials: To keep your feet dry and lower the risk of fungal infections.
Now that you understand why these shoes are so critical, let’s look at how Medicare can help cover their cost.
What Diabetic Supplies Are Covered by Medicare?
In addition to diabetic shoes, Medicare covers a range of supplies and services for managing diabetes. These include:
- Blood glucose monitors and test strips: Medicare covers these essential tools for monitoring blood sugar levels.
- Insulin: Medicare covers insulin and certain supplies used to administer insulin, such as syringes, needles, and insulin pumps.
- Diabetes self-management training: Medicare covers diabetes education classes to help you learn how to manage your diabetes and improve your health.
- Foot exams: Medicare covers foot exams for people with diabetes to check for foot problems.
What Kind of Shoes Are Best for Diabetics?
Choosing the right shoes is crucial for individuals with diabetes to prevent foot complications. Here are some key features to look for in diabetic shoes, as recommended by Siren:
- Extra-depth: Diabetic shoes should have extra depth to accommodate orthotic inserts and reduce pressure on your feet.
- Soft, seamless interior: Shoes should have a soft and seamless interior to minimize friction and reduce the risk of developing blisters or ulcers.
- Wide toe box: A wide toe box provides room for your toes and helps prevent rubbing and irritation.
- Adjustable closures: Shoes with adjustable closures such as Velcro straps or laces allow for a customized fit and accommodate changes in foot size.
- Breathable material: Choose shoes made from breathable materials to keep your feet dry and reduce the risk of fungal infections.
Does Medicare Pay for Shoes for Seniors?
Yes, Medicare shoe coverage is available for seniors who are enrolled in Medicare Part B and meet the criteria for diabetic shoes prescribed by a doctor. Medicare Part B covers 80% of the Medicare-approved amount for diabetic shoes and inserts, and you are responsible for the remaining 20% coinsurance.
According to MedicareABC, the shoes must be provided by a Medicare-approved supplier who participates in the Medicare program.
Medicare Coverage for Diabetic Shoes
Medicare Part B does cover diabetic shoes for eligible individuals, including both extra-depth and custom-molded options. However, you must meet specific criteria to qualify.
Eligibility Requirements
To get coverage for diabetic shoes under Medicare, here’s what you’ll need:
- Diagnosis of Diabetes.
You must have diabetes that’s managed with regular medical care. - Foot Conditions That Increase Risk.
Medicare requires that you have at least one of these risk factors:- History of foot ulcers
- Pre-ulcerative calluses
- Nerve damage (peripheral neuropathy) coupled with callus formation
- Foot deformities (like hammertoes or bunions)
- Poor circulation affecting your legs or feet
- Doctor’s Prescription and Certification.
Your primary doctor and a podiatrist (or other foot specialist) must confirm that diabetic shoes are medically necessary and prescribe them. They’ll submit the paperwork for Medicare approval. - Medicare-Approved Suppliers.
You must purchase your shoes through a supplier or fitter enrolled in the Medicare program.
How to Get Medicare-Covered Diabetic Shoes
If you’re ready to get the right shoes for your foot health, don’t worry! The process is straightforward. Here’s a breakdown:
- Speak with Your Primary Doctor
Begin by discussing your foot health during your regular diabetes check-up. Share any concerns or symptoms you’ve noticed, such as numbness, tingling, slow-healing sores, or added discomfort in everyday shoes. - Visit a Specialist
After diagnosing your need, your doctor may refer you to a podiatrist or similar specialist to evaluate your foot conditions in more detail. This step ensures Medicare has the necessary documentation. - Get a Prescription
Once your doctor certifies that shoes are medically necessary, they’ll write a prescription that aligns with Medicare standards. - Find a Medicare-Approved Supplier
Not all shoe providers are Medicare-approved, so it’s important to choose a supplier from their official directory. Your doctor’s office can help you find one nearby, or you can explore Medicare’s supplier directory online. - Submit for Coverage
Medicare will handle the billing between your doctor, supplier, and themselves. Once approved, your shoes are ready for pickup or delivery.
Need assistance? The Mair Agency can help you take these steps with ease. Contact us today to get started.
Contact the Mair Agency Today for Medicare Guidance
Navigating Medicare can be confusing, but you don’t have to do it alone. At the Mair Agency, we specialize in helping individuals across North Carolina access their full range of Medicare benefits. Whether it’s diabetic shoes, supplemental plans, or general Medicare questions, our team will make the process simple and stress-free.
Why Choose the Mair Agency?
- Personalized Support: We tailor our guidance to your needs, ensuring you understand all your options.
- Experienced Team: With decades of experience, we’ve helped thousands of people make sense of Medicare.
- Full-Service Assistance: From navigating claims to finding the right suppliers, we’re here every step of the way.
Take the first step toward better foot health and overall well-being. Contact us today or check out our free Medicare course to get started.
Your health matters. Trust the Mair Agency to help you walk the path toward care and confidence.
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