Why Does Medicare Pay For Diabetic Shoes
Diabetic Shoes are paid for by Medicare, but have you ever wondered why? What makes diabetic shoes an essential part of any diabetic healthcare plan?
Itâs as simple as saving limbs saves them money⦠Patients with diabetes have inadequate blood flow to the extremities because of the fluctuation in blood sugar levels. 65% of patients with diabetes have mild to severe forms of nerve damage resulting in impaired sensation in the feet. When you have loss of a protective sensation and arenât wearing properly fitting shoes sores can develop quickly. Inadequate blood flow inhibits healing. Therefore, sores on the feet are slow to heal and can often lead to amputations.
Properly fitted diabetic shoes are very important in preventing foot injuries. Diabetic shoes are designed to protect feet by combining special features and materials .
It is also very important that the patient sees a certified shoe fitter who is trained to ensure the patient has properly fitting shoes as the patient often cannot feel areas of their feet that can incur injury with improper fitting shoes.
Dietitians At Home has a certified shoe fitter that will go to your patientsâ homes to properly fit them for shoes and show them different styles. Our shoe fitter will also deliver the shoes to the patientsâ homes so that they are there when the patient tries them on to confirm a proper fit.
A good foot care regimen including proper footwear can reduce diabetic foot amputations by 85%!!!
What Does This Mean For Me
Should you be a Medicare Beneficiary with Medicare Parts A and B, have diabetes, and you have reasons for requiring diabetic shoes that could fall under Medically Necessary, you could very well be eligible. Do keep in mind that if you are only covered through Traditional Medicare, the costs that will fall under your responsibility will include meeting your Part B deductible and the twenty percent coinsurance.
If you have extra coverage, such as the Medicare Supplement plan, you could very well wind up spending less on diabetic supplies and services. If you are a Medicare beneficiary, you may want to think about enrolling in the Medicare Part D Prescription Drug plan. Prescription Drug plans can aid in covering the expenses of your daily diabetic prescriptions.
Some beneficiaries may perceive that the most helpful assistance available for them is in a Medicare Advantage plan. You are advised to speak with an insurance agent licensed in your state. This person will aid you in identifying the most advantageous and feasible plan for you.
What Does Medicare Cover For People With Diabetes
Medicare covers 80% of the below products. Insurance holders by an annual deductible as well as the remaining 20% of all expenses. Some individuals may have private insurance to supplement this remaining 20%, making many of these items free of charge for insurance and Medicare holders.
The information listed below is subject to change at any time. Please check directly with Medicare to confirm coverage.
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Does Medicare Cover Orthopedic Shoes
Medicare coverage of orthopedic shoes is generally limited to people with diabetes and severe diabetic foot disease. Medicare Part B may cover the fitting and purchase of either one pair of custom-molded orthopedic shoes and inserts each calendar year or one pair of extra-depth orthopedic shoes each calendar year. Medicare may also cover shoe modifications instead of inserts. In addition, Medicare may cover two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts each calendar year for extra-depth shoes. Even if you have diabetes, a doctor such as a podiatrist, must certify that you need orthopedic shoes or inserts. Further, your orthopedic shoes or inserts must be supplied by an orthotist, prosthetist, pedorthist or other qualified individual trained in treatment of the conditions of the foot and ankle.
If your supplier accepts Medicare assignment, you generally pay 20% of the Medicare-approved amount and the Medicare Part B deductible applies. Your doctors and suppliers also must be enrolled in Medicare for Medicare to provide coverage for your orthopedic shoes.
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Medicare Guidelines For Diabetic Shoes And Inserts
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A pedorthic device is created to treat a variety of possible foot-related problems such as congenital deformity, improper walking and partial foot amputations. If you are covered by Medicare Part B, you qualify for therapeutic shoes and/or inserts. Medicare coverage can help prevent suffering while saving you money!
Medicare Part B covers one pair of therapeutic shoes and/or inserts and one fitting each calendar year. If you qualify, you are limited to one of two types of the following shoes each year:
- One pair of depth-inlay shoes and three pairs of inserts
- One pair of custom-molded shoes if you cant wear depth-inlay shoes because of a foot deformity, and two addition pairs of inserts.
In order for Medicare to cover the cost of your therapeutic shoes, the doctor treating your diabetes must verify that you meet three conditions:
Medicare also requires that:
- Your doctor confirms your need for therapeutic shoes or inserts.
- A podiatrist or other qualified doctor prescribes them.
- Your items are provided by a podiatrist, orthotist, prosthetist or pedorthist
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Will Medicare Cover The Costs Of My Foot Care
Your podiatrist foot exams and treatment are covered by Medicare Part B should you have nerve damage related to diabetes or have a medical necessity for treatments of foot diseases or injuries such as hammertoe, heel spurs or bunion deformities.
It covers exams for diabetic peripheral neuropathy and loss of protective sensations every six months. You must not see a foot care professional for any other reason between visits. You would only pay twenty percent of the Medicare-approved amount.
The Part B deductible applies. If this is a hospital outpatient setting you would also pay a copayment for medically necessary treatment. Talk with your doctor or health care provider about the specific amount owed. Medicare does not generally cover the costs of routine foot care.
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Why Are Sas Shoes Good For Diabetic Feet
The SAS Shoe company provide a complete line of Diabetic shoes that provide good quality comfortable shoes with excellent fit. These shoes help in preventing the foot injury due to the following factors:
The shoes are roomy in the toe box and do not put pressure on the ball of the foot. The snug fitting of the heel prevents the slipping of the shoes. The top will prevent ulceration because they will not rub against your feet. The footbed is antimicrobial, washable and will prevent foot infection. The Tripad material provides an odor resistant environment and excellent cushioning that will help in preventing pressure points at the ball of the feet and heels. EZ lacing system and SAS tongue holder will also benefit to diabetic feet in preventing further injury to the feet.
If you are a diabetic and on feet all day, the SAS Time Out for men and SAS Free time for women will help by providing the comfort that diabetic feet need.
SAS Free Time Mesh Shoes for Women
Looking to buy the cushioned shoes for standing? If you are in search of quality shoes that are worth your investment, then it may be practical enough to choose SAS free time shoes. This brand of footwear has been on the market for decades, and you can expect superior comfort, durability, and style from these shoes.
Key Benefits You Can Expect
Features of the Footwear
A Few Points to Consider
SAS Timeout Diabetic Shoe
Features and Their Benefits
SAS VTO
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How Do Medicare Health Plans Cover Diabetic Shoes
Medicare Advantage plans, available from private, Medicare-approved insurance companies, must cover everything that Original Medicare cover except for hospice care, which Part A covers. So if you have a Medicare Advantage plan, it should cover diabetic shoes as described above if the conditions are met.
If you dont have a Medicare Advantage plan, you may be able to enroll in a Medicare Supplement plan to help pay for Original Medicares out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
If you need help understanding how your current plan covers diabetic shoes, and youre enrolled in a Medicare Advantage plan or a Medicare Supplement plan, you may want to call your insurance company. You can also contact Medicare 24 hours a day and seven days a week: 1-800-Medicare or 1-877-486-2048 for TTY.
Would you like to find out about the various Medicare plan options and how they work? If so, Im here to help you search for the Medicare coverage options in your vicinity.
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How Much Do Diabetic Shoes Cost
Diabetic shoes can be costly because theyre a specialty shoe. Shoes will need to be customer-fitted for your feet.
Most diabetic shoes can range in cost from $50-$200 per pair.
Thankfully, Medicare does cover these shoes in most cases. But if you dont have insurance, you could be paying these high costs yourself.
Medicare Reimbursement Directly To The Patient
If the local prescribing physician does not accept Medicare assignment, and there is not a local qualified provider that does, the patient has the option of paying the provider the entire amount, and then applying for reimbursement directly from Medicare for 80% of the allowable amount. The Centers for Medicare & Medicaid Services will reimburse 80% of the amount it designates as “allowable, and the patient is responsible for paying 20% of the total payment amount. In order to qualify for coverage the patient must be fitted by a qualified provider, so it is not possible for a patient to purchase footwear directly from a manufacturer or a retail facility or online e-commerce store and then request the 80% reimbursement from Medicare.
NOTE: Some Medicare suppliers may not accept assignment if the allowable amount is too low to cover the appropriate materials and services. In these situations, the total cost to the patient may be higher than the allowable amount. If so, the patient may be expected to pay the Medicare supplier in full before he or she receives reimbursement from Medicare.
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Dr Comfort Diabetic Shoes From Indiana Podiatry Group
If the Shoe Fits: Dr. Comfort Diabetic Shoes May Save Your Legs If You Are Diabetic Diabetic shoes are specially designed shoes for use in diabetics who are at risk for developing foot problems from poorly fitting shoes. Diabetics often have poor sensation in their feet, and may not feel if a shoe is causing excessive rubbing on the skin. This excessive rubbing can lead to skin wounds and possible infection, and in the worst case can lead to amputation. A diabetic shoe helps to prevent this by reducing pressure on the foot. Diabetic shoes are extra deep, and have increased width to prevent the top and sides of the shoe from contacting the foot skin. These shoes also come with a soft insert made of a special material called plastizote that reduces pressure and friction on the bottom of the foot. By reducing pressure and friction, the likelihood of a diabetic developing serious wounds on the sole of the foot or heel is significantly reduced. These shoes are an important part of the preventative care diabetics need to reduce the risk of amputation, and are especially needed in those with poor sensation, poor diabetes control, foot deformity like bunions or hammertoes, or calluses and corns.Continue reading > >
Patient Responsibility For Payment
Medicare will pay for 80% of the Medicare-approved amount either directly to the patient or by reimbursement after the Part B deductible is met. The patient is responsible for a minimum of 20% of the total payment amount and possibly more if the dispenser does not accept Medicare assignment and if the dispenser’s usual fee is higher than the payment amount.
Medicare pays only for therapeutic footwear from Medicare-approved suppliers, reimbursing 80% of the cost either to the patient or after the Part B deductible is met. The patient is responsible for the other 20% — or more if the supplier does not “accept assignment” from Medicare.
Medicare.gov: Medicareâs Coverage of Diabetes Supplies & Services.
The National Institute of Diabetes and Digestive and Kidney Diseases of The National Institutes of Health. Publication: Feet Can Last a Lifetime: Medicare Coverage of Therapeutic Footwear for People with Diabetes. 1998.
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Medicares Therapeutic Shoe Benefit
The Centers for Disease Control and Prevention estimates that 23.1-million Americans have been diagnosed with diabetes. Studies have shown that 25 percent of persons with diabetes develop foot problems related to the disease and that up to 15 percent of persons with diabetes develop foot ulcers.
Since 1993, Medicare has covered certain therapeutic shoes, inserts and modifications for persons with diabetes who meet specified qualifying requirements.
Medicare covers diabetic shoes, inserts and modifications for program beneficiaries only if the following criteria are met*:
The patient has diabetes and one or more of the following conditions:
- Previous amputation of the other foot, or part of either foot, or
- History of previous foot ulceration of either foot, or
- History of pre-ulcerative calluses of either foot, or
- Peripheral neuropathy with evidence of callus formation of either foot, or
- Foot deformity of either foot, or
- Poor circulation in either foot
The patient has a prescription for a particular type of footwear from a podiatrist or physician who is knowledgeable in the fitting of diabetic shoes and inserts.
A Statement of Certifying Physician for Therapeutic Shoes from a physician who manages the patients diabetes, which certifies that the patient has diabetes mellitus, has at least one of the qualifying conditions , is being treated under a comprehensive plan of care for his or her diabetes, and needs diabetic shoes.
Will Medicaid Pay For Diabetic Shoes
As a Medicare and Medicaid diabetic shoe supplier in Colorado,there are provisions for shoes to be supplied to individuals withDiabetes. Since MedicAID is a joint federal-state funded programfor the indigent that is run by each state, there can be variationsin the benefits provided in each state. Capitalizing AID and ARE isemphasis so readers will be made aware of which program is beingreferred.
But typically if MedicARE provides for an item or service, then the state MedicAIDprogram will also supply but with the state’s limits imposed.MedicARE benefit is for one pair of shoes and three pair of insertsper calendar year. Since a person can be dropped out of MedicAID iftheir income exceeds a certain level, Colorado’s MedicAID programdoes not pay for 3 pair of inserts for a year’s use as that personmay be dropped from the MedicAID rolls the following quarter due totheir income increasing.
Therapeutic shoes for diabetes as a MediCARE benefit is 80%covered by MediCARE. If the individual has a secondary policy thatdoes cover the other 20%, then there could be no out of pocket cost. So it is inappropreate to refer to “free” Medicare diabeticshoes. MediCAID in Colorado has $1.00 copayment.
So the term “diabetic shoe” really means a properly fit, goodshoe that meets the standards of the primary healthcare plan thatoffers that benefit, MedicARE.
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To Find A Supplier/qualified Provider For Your Shoes And Inserts
If your treating physician doesnt point you in the right direction, here are some tools to locate qualified providers/suppliers for your shoes and inserts.
To find a Podiatrist you can use the locator tool on the American Podiatric Medical Association website here.
To find a Pedorthist you can use the locator tool on the Pedorthic Footcare Association website here.
To find a Prosthetist you can use the locator tool on the Prosthetist Finder website here.
To find an Orthotist you can use the locator tool on the American Board for Certification in Orthotics, Prosthetics and Pedorthics here.
Obviously you can use the last locator to find Pedorthists and Prosthetists as well as Orthotists.
Remember to only use Medicare-approved suppliers and those who accept assignment !