A Senior’s Guide: How to Buy Medicare Approved Shoes?

Over 38 million Americans live with diabetes, many of whom are eligible for therapeutic shoes under Medicare's coverage. For those with specific foot conditions, knowing how to buy medicare approved shoes? is an essential step towards better foot health and mobility. This guide outlines the necessary process to ensure you get the right footwear with Medicare support.

Quick Summary

Getting Medicare-approved therapeutic shoes requires certification from your treating physician, a prescription from a qualified provider, and purchasing from a Medicare-enrolled supplier who accepts assignment, ensuring eligibility and limiting your out-of-pocket costs.

Key Points

• Doctor's Certification First: Obtain a certification statement from your physician that confirms your diabetes and qualifying foot condition before taking any other steps.

• Prescription Required: A prescription from a qualified provider, such as a podiatrist, is needed to specify the type of therapeutic shoes and inserts.

• Supplier Enrollment is Crucial: Only purchase from a supplier who is actively enrolled in Medicare to ensure your claim is covered.

• Acceptance of Assignment: To avoid unexpected and potentially large bills, always verify that your supplier accepts assignment from Medicare.

• In-Person Evaluation is Mandatory: Medicare requires an in-person evaluation by the supplier at the time of fitting and delivery to verify the shoes' fit and suitability.

• Qualifying Conditions Apply: Coverage is not for standard orthopedic shoes, but specifically for diabetic patients with severe foot complications.

• Annual Benefit Cycle: Understand that the benefit covers one pair of shoes and inserts per calendar year for eligible individuals.

Understanding Medicare's Therapeutic Shoe Benefit

Medicare Part B covers therapeutic footwear for individuals with diabetes who have specific foot conditions. This benefit includes one pair of custom-molded or depth shoes and up to three pairs of inserts per calendar year, depending on your needs. The primary goal is to prevent foot complications, which are common with diabetes.

Are You Eligible for Therapeutic Shoes?

To be eligible for Medicare-approved shoes, you must have diabetes and at least one of the following foot conditions, as certified by your physician:

• History of partial or complete foot amputation
• History of previous foot ulceration
• History of pre-ulcerative calluses
• Peripheral neuropathy with evidence of callus formation
• Significant foot deformity
• Poor circulation in either foot

The Step-by-Step Process to Purchase Medicare-Approved Shoes

Acquiring your therapeutic shoes is a systematic process that involves several key players. Following these steps carefully will help ensure your purchase is covered.

1. Visit Your Doctor: Your first step is to visit the physician who manages your diabetes care. They must perform an in-person visit where they evaluate your condition and officially certify your need for therapeutic shoes. This must happen within six months before the shoes are delivered.
2. Get a Prescription: Next, you will need a prescription for the shoes from a qualified provider, which can include a podiatrist, orthotist, or the certifying physician themselves. The prescription must be signed within three months before the delivery date.
3. Find a Medicare-Enrolled Supplier: You must obtain your shoes from a supplier who is enrolled in and approved by Medicare. Suppliers must meet strict standards to maintain their enrollment.
4. Confirm the Supplier Accepts Assignment: This is a crucial step to manage your costs. When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment. This means you will only be responsible for the Part B deductible (if not met) and your 20% coinsurance.
5. Schedule the Fitting: The supplier must conduct an in-person fitting and assessment of the shoes to ensure a proper fit. This is a documented requirement for coverage.
6. Receive Your Footwear: After the fitting, the supplier will order and deliver your therapeutic shoes and inserts.

Finding a Reliable Supplier

Choosing the right supplier is as important as having the right documentation. Look for suppliers with a strong reputation for customer service and quality footwear. They should be transparent about the process and knowledgeable about Medicare requirements. You can verify a supplier's Medicare status through official Medicare resources.

What to Expect at the Shoe Fitting

During your fitting, the pedorthist or orthotist will take precise measurements of your feet. They will consider any deformities, areas of pressure, or special needs to ensure a perfect fit that addresses your specific condition. You may try on various styles to find the most comfortable and supportive pair.

Comparison: Navigating Costs with Different Supplier Types

Feature	Participating Supplier (Accepts Assignment)	Non-Participating Supplier (Does Not Accept Assignment)
Cost Responsibility	You pay the Part B deductible and 20% of the Medicare-approved amount.	You pay the Part B deductible and 20% of the Medicare-approved amount, plus any extra charges above the approved amount.
Bill Limit	Cannot charge you more than the approved amount and your coinsurance.	Can charge you an unlimited amount above the Medicare-approved rate.
Accepts Claim?	Submits the claim to Medicare on your behalf.	May or may not submit the claim. You might have to submit it yourself for partial reimbursement.

Finalizing Your Purchase

Once you have found your shoes and completed the fitting, the supplier will submit the claim to Medicare. If you have any issues with the process or your claim, contact your Medicare plan administrator. It's always a good idea to keep copies of all your documentation, including the certification statement and prescription, for your records.

Conclusion

Navigating the process for Medicare-approved footwear can seem complex, but with the right steps, it is straightforward. The key lies in proper medical certification, a valid prescription, and working with a qualified, Medicare-enrolled supplier who accepts assignment. This ensures you receive the necessary protection for your feet, contributing to your overall health and well-being. For additional resources and information, refer to the Medicare.gov guidance on therapeutic shoes and inserts.

Frequently Asked Questions

Does Medicare cover standard orthopedic shoes?

No, Medicare's coverage for therapeutic footwear is specifically for individuals with diabetes who also have severe foot conditions that put them at risk for foot complications. Standard orthopedic shoes are not typically covered under this benefit.

Can I get new inserts every year with my shoes?

Yes. If you qualify for therapeutic shoes, Medicare covers one pair of shoes and up to three pairs of inserts per calendar year.

What is the role of the 'certifying physician'?

The certifying physician is the doctor (M.D. or D.O.) who manages your diabetes and certifies that you meet the specific medical criteria for therapeutic shoes. They must document this in your medical record.

What happens if I go to a supplier not enrolled in Medicare?

If you use a supplier that is not enrolled in Medicare, your claim will not be paid. It is critical to confirm the supplier's enrollment status before making a purchase.

Why is it important to ask if a supplier 'accepts assignment'?

Asking if a supplier accepts assignment is important because it limits your out-of-pocket costs. They can only charge you the Medicare-approved amount plus your coinsurance and deductible. If they don't accept assignment, they can charge you any amount they want.

What documentation do I need to prepare?

You will need a certification statement from your treating physician, a prescription from a qualified provider, and documentation of the in-person fitting conducted by the supplier.

Can a nurse practitioner (NP) or physician assistant (PA) certify my need?

An NP or PA can certify the need, but their notes must be reviewed and signed by the supervising physician (M.D. or D.O.) who is overseeing the patient's comprehensive treatment plan.