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Does Medicare Cover Podiatry? 

Routine foot care like hygiene maintenance and callus removal are usually not covered by Original Medicare

However, Medicare Part B will generally cover podiatry care in an outpatient setting if it’s medically necessary, such as for diabetes-related nerve damage, foot injuries, or diseases like bunion deformities, hammer toe, or heel spurs. It may also cover therapeutic shoes and inserts if your podiatrist prescribed them.

On the other hand, Medicare Part A may cover the cost of inpatient podiatry care if you’re admitted to a Medicare-approved hospital. 

Understanding Medicare Coverage for Podiatry 

Aging can take a toll on your entire body, including your feet. Understand how Medicare coverage for podiatry services works so you can make informed decisions about your foot health and receive the necessary care without incurring hefty out-of-pocket expenses.

Eligibility

For Original Medicare to cover your visit to the podiatrist, you typically need to meet the following eligibility requirements:

  • You’re enrolled in Original Medicare.
  • You have diabetes-related nerve damage in your foot/feet or require medically necessary treatment for foot injuries or diseases like bunion deformities, heel spurs, and hammer toe. 
  • Your healthcare provider who provides the service participates in Medicare.

Part A Coverage 

Medicare Part A, often called hospital insurance, primarily covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. If your foot treatment requires hospitalization, Medicare Part A may cover 100% of hospital-specific costs for the first 60 days of the stay. After 60 days, you’re responsible for paying the coinsurance that Part A doesn’t cover.

Part B Coverage 

Medicare Part B covers outpatient and preventive services, including doctor visits, lab tests, diagnostic screenings, and medical equipment. It typically covers any medically necessary podiatry services ordered by your physician. These services often include exams or treatment for diabetes-related nerve damage, foot injuries, or diseases like hammer toe, bunion deformities, and heel spurs. As long as your doctor prescribes them, Medicare Part B may also cover podiatry items like therapeutic shoes and inserts to reduce your foot pain and prevent further injuries to it. 

Medigap

Medigap, also known as Medicare Supplement Health Insurance, is sold by private insurers to help beneficiaries fill the gaps in Original Medicare coverage. For example, if you’re left with a $550 out-of-pocket bill for podiatry services after your Medicare Part B <a class=”wpil_keyword_link” href=”https://assurance.com/health-insurance/copays-deductibles-and-coinsurance kicks in, your Medigap policy could help shoulder a portion or all of the cost. 

How Does Medicare Advantage Cover Podiatry? 

Medicare Advantage plans, sometimes called Medicare Part C, are offered by private companies approved by Medicare and must cover, at minimum, what Original Medicare covers. While not required, many Medicare Advantage Plans often offer extra benefits such as dental care, eyeglasses, wellness programs, and even routine foot care. If you’re enrolled in a Medicare Advantage plan, check the specifics of your policy to understand what’s covered. 

How Much Does Podiatry Cost With Medicare? 

The cost of podiatry services can vary widely. Simple procedures such as a routine foot exam may cost around $60-$400 out of pocket, while treatments for more complex issues like bunions and heel spurs could range from $500 to $5,000 or more. The good news is that if you’re a Medicare beneficiary, you could get up to 80% of the treatment costs paid for with Part B coverage after meeting your annual deductible of $226 in 2023. Besides your deductible and 20% coinsurance, you must also pay a monthly Part B premium of around $164.90 in 2023. 

Medicare Advantage Costs 

The cost of podiatry services under a Medicare Advantage plan can vary significantly depending on the specifics of your plan. Generally, Medicare Advantage plans require you to pay a low or $0 monthly plan premium in addition to your Medicare Part B premium. You may also be responsible for copays, coinsurance, and deductibles. Check with your plan provider for more details on your coverage and out-of-pocket costs

How to Get Podiatry Services Through Medicare

Paying for podiatry services entirely out-of-pocket could put a dent in your wallet. Here’s how to get your foot-related treatments or surgeries covered through Medicare. 

  • Choose a podiatrist who participates in Medicare: You can use the Medicare provider search tool to find participating providers.
  • Check with your Medicare plan: Contact Medicare at 1-800-633-4227 to confirm coverage for the podiatry services you’re hoping to receive. 
  • Schedule an appointment with the podiatrist: Your podiatrist will examine your condition and determine whether it requires medically necessary procedures.
  • Obtain a letter of medical necessity: If your podiatrist deems a podiatry service medically necessary, make sure they write a prescription and a letter of medical necessity. 
  • Submit a claim: Most healthcare providers will file a claim with Medicare on your behalf so you can receive Medicare reimbursement for the covered service. 

All in All

While Original Medicare may not cover routine foot care, it will generally help pay for services deemed medically necessary by your podiatrist. However, suppose you need financial assistance with services like hygienic maintenance, callus removal, or nail trimming. In that case, it may be worth considering Medicare Advantage plans that often offer extra benefits that Original Medicare does not. 

A pair of healthy feet can keep you active and healthy in your golden years, so do not wait until there’s a problem to look into your health insurance coverage options. Start exploring them now to ensure your feet are properly cared for without breaking the bank.

Frequently Asked Questions 

In general, there’s no upper dollar limit on Medicare benefits if you require medical services that Medicare covers, such as treatment for foot diseases like heel spurs. However, Medicare only covers foot exams twice a year if you have diabetes‑related lower leg nerve damage that can increase the risk of limb loss. 

No, not all podiatrists accept Medicare. You can find out if a podiatrist is Medicare-certified by using the “Medicare Physician & Other Practitioner Look-up” tool. It allows you to search for healthcare professionals by name, location, or National Provider Identifier (NPI). 

If Medicare decides not to cover your podiatry service, you have the right to appeal the decision. But before appealing, it’s best to talk with your healthcare provider and Medicare to see if you can identify the problem and resubmit the claim. If that does not work, check the denial notice to find out the specific steps on how to appeal Medicare’s decision. 

Medicare Part B typically provides coverage for preventive podiatry services, including semi-annual foot exams for individuals with diabetes who are at high risk for foot problems. However, it’s always a good idea to check with a healthcare provider or Medicare representative for accurate information on coverage for preventive podiatry services. 

Medicare covers treatment and surgeries for foot/feet problems whenever medically necessary. Some of the most common foot surgeries covered by Medicare include surgical procedures for hammertoe, corrective surgery for bunion, and heel spur removal. 

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