Medicare Diabetic Shoes - Eligibility & Requirements

By: Meredith Miller
Published: Thursday, September 27 2018
Last Updated: 2 months ago

Foot ulcers are a common occurrence in people with diabetes in the United States. Studies show that as many as 15% of those diagnosed with diabetes will experience a foot ulcer at some point in their lives. Statistics show that up to 24% of those diabetics who develop foot ulcers will require surgery and possibly amputation. In the US, where diabetes is attributed to many complications, more than 82,000 lower extremity amputations are performed each year. This is why diabetic shoes are often prescribed for preventative care.

Anatomy Of Shoes For Diabetics

Shoes for diabetics are designed to reduce the risk of the skin breaking down in diabetics, who in general terms are at greater risk of diseases. Germs tend to be attracted to cuts, scrapes or open skin wounds in this area of the body, which often receives less hygienic care than other body parts. Floor surfaces and the moist, warm environment in shoes tend to be breeding grounds for disease.

Diabetic shoes are intended to prevent complications which may occur. Particularly strains, skin ulcers, calluses and open wounds which may lead to infections, surgery or even amputations.

Prescribed by a physician, the shoes are required to include a removable orthotic device, such as an arch support, a shoe insert, a lift, a heel, or a custom molded prescription insert. Diabetic shoes differ from standard shoes by having a wider, higher toe box to reduce friction and increase circulation. They are wider to prevent blistering and have more depth to provide extra stability.

Does Medicare Cover Diabetic Shoes

Costs of specialty shoes can be expensive. Many private insurance companies, as well as Medicare, which provides for the disabled and the elderly, do cover diabetic shoes, often referred to as Medicare diabetic shoes. In addition, under certain guidelines by CMS (Center for Medicare Services) they may approve coverage for modified shoes rather than traditional Medicare diabetic shoes with the required inserts.

Shoes come in many forms and types, whether athletic shoes and sneakers, slip-on, dress or casual shoes. Contact a podiatrist to determine which shoes will work best. They will be familiar with Medicare diabetic shoes prescription and fulfillment requirements for Medicare and work to protect a patient's feet.

Diabetic shoes Medicare provides are available at many locations. A simple internet engine search for diabetic shoe medicare will provide a plethora of suppliers of authorized Medicare diabetic shoe suppliers.

From local shoe stores and specialty foot care facilities, there are also many online retail sellers offering diabetic shoes Medicare provides coverage under their Part B medical plan. Prosthetic and orthotics businesses specialize in creating diabetic shoes for individuals and are an excellent source.

Eligibility And Requirements For Diabetic Shoes Medicare Coverage

To be eligible for insurance or Medicare coverage a doctors prescription is required. Depending on insurance coverage it may be your primary provider who writes the prescription or a certified podiatrist or orthopedic doctor or a Non-Physician Practitioner (NPP). These professionals are trained in the requirements of Medicare insurance coverage requirements. Services are coverage under Medicare Part B.

When checking with Medicare about eligibility and coverage Medicare provides, the manual states that coverage by Medicare for diabetic or therapeutic shoes is based on Social Security Act §1862(a)(1)(A). Inserts are based upon the Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). All benefits are based upon a reasonable and necessary need.

This is determined during an examination by the diabetic person's healthcare provider, such as a doctor or podiatrist. The physician will provide a prescription after they diagnose the shoes are necessary for the proper treatment and proper functioning of the foot/feet of the individual patient. By having a prescription requirement Medicare ensures that proper records are maintained in the patient's medical record files. The professionals involved in healthcare understand the rules and simplify the process for patients to begin receiving the care needed as quickly as possible.

It is important that diabetics discuss whether their physician recommends shoes for diabetics before a problem occurs. Maintaining overall health is important. Regular examinations are required for prevention. Just because a person feels everything is OK, the doctor may more easily determine if someone is at risk and this medical device is beneficial for good health maintenance. Medicare covers most, if not all, of the cost. This will keep diabetics healthy and secure throughout their life.

It should be noted that Medicare allows one pair of shoes per year. Three shoe modifications or 3 pairs of inserts per year are also allowed. Additional shoes require an appeal accompanied by a statement from the physician based on a new analysis of any injury or functional damage to the shoes. Many people prefer to just add inserts to non-diabetic shoes for limited use rather than the time and effort required for an appeal.