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Does Medicare Cover Podiatry?

Does Medicare Cover Podiatry?

We know our health is essential, but we often overlook the importance of foot health. However, our feet play a vital role in our daily lives. Addressing foot-related issues promptly is crucial to maintaining mobility and overall well-being. 

Proper foot care can keep you moving and getting around. Problems with your feet can be a red flag indicating serious conditions such as diabetes or circulation issues. Caring for your feet is as important as caring for other areas of your health. 

If you are enrolled in Medicare, it’s essential to understand what services are covered and any applicable restrictions or limitations. Put your feet up and keep reading as we delve into the world of podiatry and your Medicare coverage.

What is Podiatry?

Simply put, podiatry is the branch of medicine that covers your feet. Podiatrists focus on diagnosing, treating, and preventing conditions affecting your feet. 

Your doctor may suggest seeing a podiatrist for many reasons, including: 

  • Routine foot care encompasses toenail trimming, callus and corn removal, and basic foot hygiene.
  • Treatment for chronic conditions such as diabetic foot complications, plantar fasciitis, arthritis, and foot ulcers.
  • To diagnose and treat sprains, fractures, and other injuries related to the foot and ankle.
  • To perform surgical procedures to correct foot abnormalities, address injuries, or alleviate chronic pain.

Podiatry and seniors

Podiatry is especially important for seniors. 

First, our feet become more susceptible to various foot-related issues as we age. Conditions like arthritis, bunions, corns, calluses, and foot pain tend to become more common in older adults. By addressing these issues, podiatry helps older adults stay active, carry out daily activities easily, and maintain their independence.

Foot health is also closely connected to overall health and well-being, especially for seniors. When foot problems arise, they can affect balance and increase the risk of falls and related injuries. By focusing on foot health, podiatry is vital in keeping seniors safe while minimizing the chances of falls and associated complications.

Medicare Coverage for Podiatry Services

Medicare provides coverage for some podiatry services, but it’s essential to understand the specifics of this coverage.

Medicare Part B, which is Medical Insurance, provides coverage for foot exams and treatment by podiatrists (foot doctors) in specific cases. After you pay your Part B deductible ($226 in 2023), you will be responsible for 80% of the costs. 

Medicare will cover any necessary services if you have diabetes-related nerve damage or require medically-necessary treatment for foot injuries or diseases such as hammer toe, bunion deformities, or heel spurs. 

Medicare covers medically necessary foot care services for individuals with diabetes. This includes treatment for foot ulcers, neuropathy, and infections directly related to diabetes. If you have a condition requiring surgery, Medicare Part A will cover your treatment while you are in the hospital. 

Depending on your Medicare Advantage plan, you may be covered for any foot care services not covered by Original Medicare. Speak to your provider to discuss your specific coverage. 

Restrictions and Limitations on Medicare Coverage

Restrictions and Limitations on Medicare Coverage

While Medicare does provide coverage for podiatric services, there are certain restrictions and limitations to be aware of:

Medical Necessity 

To receive coverage, podiatric services must be deemed medically necessary. This means that the treatment or procedure must be required to diagnose or treat a medical condition. For example, Medicare generally does not cover routine foot care services unless it is medically necessary. Routine foot care services refer to such services as nail trimming, callus removal, and foot hygiene.

Frequency Limitations 

Medicare may impose limits on the frequency of coverage for certain podiatric services. For instance, medically necessary routine foot care is typically limited to once every 60 days. Medicare will also only cover foot exams every six months. 

Orthopedic and Other Specialty Shoes

Your podiatrist may recommend that you wear orthopedic or therapeutic shoes

Medicare Part B will cover orthopedic shoes only if they are part of a leg brace. It also covers specific footwear each year for individuals with diabetes and severe diabetic foot disease. This includes one pair of custom-molded shoes and inserts, one pair of extra-depth shoes, and additional inserts. You can also have your shoes modified instead of getting inserts. 

As with other Medicare Part B expenses, you must pay 20% of the cost after paying your annual deductible. 

Finding Qualified Podiatrists and Ensuring Medicare Coverage

To ensure that Medicare covers your podiatric services, consider the following tips.

Before scheduling an appointment, confirm that the podiatrist you plan to visit accepts Medicare assignment. Ask your primary care doctor or other healthcare providers to recommend a qualified podiatrist who accepts Medicare.

When being treated by a podiatrist, ensure they properly document your diagnosis and treatment plan. They must outline clearly why the treatment is medically necessary. 

Making the right steps with The Medicare Family

There are so many choices regarding your Medicare coverage that it can be hard to know the proper steps. You do not need to make these decisions alone! At The Medicare Family, we have been helping seniors start their Medicare journey on the right foot for over 40 years. 

Schedule your free consultation to learn more about how The Medicare Family can help you. 

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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