Medicare Part B (Medical Insurance) covers one pair of therapeutic shoes and inserts as durable medical equipment (DME), and the fitting each calendar year. Medicare will cover shoe modifications instead of inserts.
All people with Medicare who have diabetes and severe diabetic foot disease are covered. Your doctor must certify that you need Therapeutic shoes or inserts. A podiatrist or other qualified doctor must prescribe these items and they must be provided by one these:
• A podiatrist
• An orthotist
• A prosthetist
• A pedorthist
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount. Medicare pays for different kinds of DME in different ways: some equipment may be rented, other equipment may be purchased, and you may choose to rent or buy some equipment.
Medicare will only cover your DME if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn’t accept assignment, Medicare doesn’t limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare’s share) at the time you get the DME.
Competitive Bidding Program
If you live in certain areas of California, Florida, Indiana, Kansas, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina, or Texas, you may be affected by Medicare’s Competitive Bidding Program. In most cases, if you have Original Medicare and get program items in program areas, Medicare will only help pay for these items if they’re provided by contract suppliers. More areas will be added in 2013.