Key Takeaways

• Medicare Part B covers one pair of therapeutic diabetic shoes plus three pairs of inserts annually for qualifying beneficiaries
• To qualify, you must have diabetes, a documented foot condition, and certification from both your primary doctor and a podiatrist
• Proper diabetic footwear can reduce amputation risk by up to 85%, making this Medicare benefit potentially life-saving
• Medicare covers 80% of the approved amount for diabetic shoes, with beneficiaries responsible for the remaining 20% coinsurance
• Using a Medicare-approved supplier is essential—otherwise, you might be responsible for the full cost of your diabetic footwear

If you’re living with diabetes and worried about foot complications, I have excellent news that could save both your feet and your wallet. Medicare’s coverage for therapeutic footwear is one of the most valuable yet underutilized benefits available to diabetes patients.

Proper footwear isn’t just a comfort issue when you have diabetes—it’s a critical health intervention that can prevent serious complications. With Advanced Health Pharmacy helping patients fit into Diabetic Shoes and navigate Medicare coverage, we’ve seen firsthand how the right shoes can transform lives and prevent devastating outcomes.

Why Diabetic Shoes Matter: The Foot Health Crisis for Diabetes Patients

When you have diabetes, your feet become vulnerable battlegrounds where small problems can quickly escalate into serious medical emergencies. Understanding why specialized footwear matters requires looking at the alarming statistics that demonstrate just how critical proper foot care becomes with this condition.

The Alarming Statistics of Diabetic Foot Complications

The numbers tell a sobering story about diabetes and foot health. Approximately 15% of people with diabetes will develop a foot ulcer during their lifetime. Even more concerning, diabetes-related amputations account for more than 60% of non-traumatic lower-limb amputations in the United States. Most devastatingly, after a lower extremity amputation, the five-year mortality rate is between 50-80%—higher than many forms of cancer.

These statistics aren’t meant to frighten you, but to emphasize why Medicare’s coverage of therapeutic footwear represents such a crucial benefit. When proper intervention happens early, many of these outcomes can be prevented.

How Proper Footwear Prevents Amputations

The right shoes create a protective environment for vulnerable diabetic feet. Therapeutic footwear distributes pressure evenly across the foot, reducing stress points where ulcers commonly develop. The extra depth accommodates foot deformities and provides space for protective inserts that further reduce pressure on sensitive areas.

Research has consistently shown that appropriate diabetic footwear can reduce ulcer recurrence by 30-50% and decrease amputation risk by up to 85%. This makes Medicare’s coverage of diabetic shoes not just a convenience but potentially a life-saving benefit.

Additionally, specialized diabetic shoes minimize friction and shear forces that can damage fragile skin. Many feature seamless interiors to eliminate rubbing points and antimicrobial properties to reduce infection risk—critical protections when even minor injuries can lead to serious complications.

The Daily Pain and Mobility Challenges Without Specialized Shoes

Without proper footwear, daily activities become sources of pain and potential danger. Ordinary shoes often lack the depth and width needed to accommodate common diabetic foot issues like hammertoes, bunions, or Charcot deformity. This cramped environment creates pressure points that can quickly develop into wounds that heal poorly due to compromised circulation.

Many patients describe the sensation of walking on glass or pebbles—a symptom of peripheral neuropathy that proper cushioning in diabetic shoes helps alleviate. This pain relief alone can dramatically improve quality of life and encourage the physical activity that helps manage diabetes.

What Medicare Covers for Diabetic Footwear

Medicare’s coverage for therapeutic footwear is surprisingly comprehensive once you understand the details. The program recognizes that proper footwear is a medical necessity for people with diabetes, not a luxury or convenience item.

One Pair of Depth Shoes and Three Pairs of Inserts Annually

Under Medicare Part B, qualifying beneficiaries can receive one pair of depth-inlay shoes and three pairs of custom-molded inserts each calendar year. This annual benefit refreshes every January, meaning you can receive new footwear each year as long as you continue to meet the qualifying conditions. The three pairs of inserts ensure you can rotate them regularly for proper hygiene and extended wear, maintaining optimal protection throughout the year.

Custom-Molded Shoes for Severe Foot Deformities

For those with severe foot deformities or complications, Medicare also covers custom-molded shoes. Unlike depth shoes that come in standard sizes with modifications, custom-molded shoes are created from a cast of your foot, ensuring a perfect fit for even the most challenging foot conditions. These shoes are individually crafted to accommodate severe deformities, ulcerations, pre-ulcerative calluses, or foot dimensions that cannot be accommodated by conventional footwear.

The custom-molding process involves creating a three-dimensional model of your foot, which serves as the foundation for building a shoe that matches every contour. This precision fit distributes pressure evenly across the foot surface, dramatically reducing the risk of ulceration in highly vulnerable areas. For patients with Charcot deformity, partial foot amputations, or extreme structural abnormalities, these custom-molded shoes can be the difference between mobility and being confined to a wheelchair.

Your 20% Responsibility After Medicare Pays 80%

Medicare Part B covers 80% of the Medicare-approved amount for diabetic shoes and inserts after you’ve met your annual deductible. You’re responsible for the remaining 20% coinsurance. For a typical pair of therapeutic shoes and inserts with a Medicare-approved cost of $300, your out-of-pocket expense would be approximately $60 after meeting your deductible. This represents significant savings compared to paying full retail price, which can range from $150 to $400 for depth shoes and $300 to $1,000 for custom-molded options.

If you have Medicare Supplement (Medigap) insurance, it may cover part or all of this 20% coinsurance, further reducing your out-of-pocket costs. Additionally, if you have Medicaid as secondary coverage to Medicare (dual eligibility), your remaining costs might be fully covered. It’s worth checking with your specific plans to understand your exact financial responsibility.

5 Requirements to Qualify for Medicare’s Diabetic Shoe Benefit

Not everyone with diabetes automatically qualifies for Medicare’s therapeutic shoe coverage. There are specific criteria you must meet to access this valuable benefit. Understanding these requirements helps ensure you can successfully navigate the process.

1. You Must Have Medicare Part B

The diabetic shoe benefit falls under Medicare Part B (Medical Insurance), not Part A (Hospital Insurance). You must be enrolled in Medicare Part B to qualify for coverage. If you only have Part A or if you’ve opted for a Medicare Advantage plan, the coverage details may differ. Medicare Advantage plans must provide at least the same level of coverage as Original Medicare, but they may have different networks of suppliers or additional requirements, so check your specific plan details.

2. You Need Documentation of Diabetes

Your medical records must clearly document that you have diabetes. This diagnosis needs to be established and recorded by a qualified healthcare provider who manages your diabetes care. The documentation should include your diabetes type, treatment plan, and any related complications. Having this information clearly recorded in your medical chart is the essential first step in qualifying for Medicare’s therapeutic shoe benefit.

3. A Doctor Must Certify Your Need

Medicare requires that the doctor who manages your diabetes (typically your primary care physician or endocrinologist) certifies your need for therapeutic footwear. This certification must state that you have diabetes and that therapeutic shoes are necessary for prevention of foot complications. The certification must be renewed annually, even if your foot condition hasn’t changed, to maintain continued coverage for new shoes each calendar year.

4. You Must Have One of These Qualifying Foot Conditions

Beyond having diabetes, you must also have at least one of six qualifying foot conditions to be eligible for Medicare’s shoe benefit. These conditions include history of partial or complete foot amputation, history of previous foot ulceration, history of pre-ulcerative calluses, peripheral neuropathy with evidence of callus formation, foot deformity, or poor circulation in either foot.

The presence of these conditions must be documented by a podiatrist or other qualified foot care specialist who will complete a detailed foot examination. This specialist will note specific findings that correspond to the qualifying conditions, creating the medical justification Medicare requires for coverage approval.

Many diabetes patients are surprised to learn they qualify under these criteria. For instance, peripheral neuropathy with calluses is extremely common in long-term diabetes patients, and foot deformities like hammertoes or bunions frequently develop as the disease progresses. If you’re uncertain whether your foot condition qualifies, a thorough examination by a podiatrist can provide clarity.

5. You Need to Use a Medicare-Enrolled Supplier like Advanced Health Pharmacy

You must obtain your diabetic shoes from a supplier that is enrolled in Medicare and accepts assignment. These suppliers have met Medicare’s standards for quality and agree to accept the Medicare-approved amount as full payment for covered services. Using a non-participating supplier could result in significantly higher out-of-pocket costs or even a complete lack of coverage. Medicare’s Supplier Directory can help you locate approved suppliers in your area who specialize in diabetic footwear. Advanced Health Pharmacy is on this list and is ready to assist you with your diabetic footwear.

The Step-by-Step Process to Get Your Medicare-Covered Shoes

Navigating the Medicare system can feel overwhelming, but obtaining your covered diabetic shoes follows a straightforward process once you understand the steps. Breaking this down into manageable stages will help ensure you receive this valuable benefit without unnecessary delays or complications.

The journey to getting your Medicare-covered diabetic shoes typically takes 4-6 weeks from initial doctor visit to receiving your footwear. Planning ahead is crucial, especially if you’re experiencing foot problems or if your current shoes are worn out. Don’t wait until you develop an ulcer or serious complication—start the process while your feet are still healthy.

Many patients delay seeking this benefit because they’re intimidated by the paperwork or unsure where to start. Remember that this is a benefit you’ve earned through your Medicare contributions, and healthcare providers who work with diabetic patients are familiar with the process.

Get the Right Documentation from Your Doctor

The process begins with your primary care physician who manages your diabetes. Schedule an appointment specifically to discuss your need for therapeutic footwear. During this visit, your doctor will need to complete a Certificate of Medical Necessity that confirms your diabetes diagnosis and need for specialized shoes. This document serves as the cornerstone of your Medicare claim, so ensure it’s completed fully and accurately with all required signatures and dates.

After this initial certification, you’ll need an examination by a podiatrist or other qualified foot specialist who will document your specific foot condition. They’ll complete a detailed prescription that specifies the type of shoes and inserts required based on your foot assessment. This prescription must include details about any foot deformities, history of ulcers, or other qualifying conditions that necessitate therapeutic footwear.

Find a Medicare-Approved Shoe Fitter or Supplier

Once you have your documentation in order, locate a Medicare-enrolled supplier who specializes in diabetic footwear. These professionals have specialized training in fitting therapeutic shoes and understanding the Medicare requirements. Ask your podiatrist for recommendations, or use Medicare’s Supplier Directory to find approved providers in your area who specialize in diabetic shoes and inserts.

When selecting a supplier, consider their experience specifically with diabetic footwear rather than general shoe stores. Qualified suppliers will have certified pedorthists or similar professionals who understand the biomechanical challenges of diabetic feet. They’ll be familiar with the Medicare paperwork process and can often help ensure all your documentation is in order, preventing potential claim denials.

Advanced Health Pharmacy is an authorized Medicare supplier and offers a professional diabetic shoe fitting service in partnership with Anodyne Shoes a trusted provider of high-quality therapeutic footwear.

What to Expect During Your Fitting Appointment

Your fitting appointment is a crucial part of the process that shouldn’t be rushed. A proper fitting typically takes 30-60 minutes and involves comprehensive measurements and assessments. The fitter will measure both feet in standing and seated positions, as foot dimensions change with weight-bearing. They’ll evaluate pressure points, gait patterns, and any specific areas of concern noted by your podiatrist.

During this appointment, you’ll have the opportunity to try different shoe styles within your prescription parameters. While function always takes priority over fashion with therapeutic footwear, many modern diabetic shoes offer attractive designs that don’t look obviously medical. Your fitter should explain how specific features address your foot conditions and demonstrate proper fit indicators. Don’t hesitate to ask questions about break-in periods, wear expectations, or care instructions.

Types of Diabetic Shoes Covered by Medicare

Medicare’s coverage extends to several different types of therapeutic footwear, each designed to address specific foot challenges common in diabetes patients. Understanding these options helps you collaborate more effectively with your healthcare team to select the most appropriate solution for your needs.

Extra-Depth Shoes: Most Common Coverage Option

Extra-depth shoes provide 3/16″ to 1/2″ of additional depth throughout the shoe, creating crucial space for pressure-relieving inserts and accommodating foot deformities. This extra volume prevents friction and pressure on sensitive areas, reducing ulcer risk. The shoes typically feature soft, seamless linings to minimize skin irritation and stretchy uppers that conform to foot irregularities without creating pressure points.

These shoes come in various styles including casual, dress, and athletic options from manufacturers specializing in diabetic footwear. Despite their therapeutic design, many modern extra-depth shoes have a mainstream appearance that doesn’t call attention to their medical purpose. Medicare covers one pair of these shoes annually along with three pairs of custom inserts for qualifying beneficiaries.

Custom-Molded Shoes: For Severe Foot Problems

For those with severe foot deformities, partial amputations, or history of ulcerations, Medicare covers custom-molded shoes. These are individually crafted from a cast or digital scan of your foot, ensuring a precise fit that accommodates even the most challenging foot conditions. The custom-molding process creates a shoe that distributes pressure evenly across the entire foot surface, virtually eliminating the concentrated pressure points that lead to ulceration.

Though more expensive than extra-depth shoes, custom-molded footwear provides unparalleled protection for highly vulnerable feet. The individualized fit can accommodate Charcot deformity, significant differences between left and right feet, and unusual foot shapes that cannot be served by conventional footwear. For eligible beneficiaries with qualifying conditions, Medicare covers the additional cost of these specialized shoes.

Inserts and Modifications: Beyond the Basic Shoe

The three pairs of inserts covered annually by Medicare are often the most critical component of therapeutic footwear. These inserts are custom-fabricated to your foot contours and designed to redistribute pressure away from vulnerable areas. Made from multiple layers of materials with different density and cushioning properties, they provide both protection and support tailored to your specific foot structure.

Medicare also covers modifications to therapeutic shoes when medically necessary. These can include metatarsal bars to relieve pressure on the ball of the foot, rocker bottoms to reduce pressure during walking, wedges to accommodate limb length discrepancies, or offset heels for specific gait abnormalities. Such modifications transform standard therapeutic shoes into highly specialized tools for addressing your unique foot challenges.

When Medicare Might Deny Coverage (And What to Do)

Despite meeting all qualifications, sometimes Medicare claims for diabetic shoes are denied. Understanding common reasons for denial can help you avoid pitfalls in the application process and know what steps to take if you face a rejection.

Claim denials are frustrating but don’t necessarily mean you won’t receive coverage. Many denials result from correctable documentation issues rather than actual ineligibility. Taking prompt action to address the specific reason for denial often leads to successful coverage on appeal.

Prevention is always easier than correction, so working with experienced providers familiar with Medicare requirements for diabetic footwear significantly reduces denial risk. Suppliers who regularly process these claims know the common pitfalls and how to avoid them.

Missing or Incomplete Documentation

The most common reason for denial is incomplete or insufficient documentation. Medicare requires very specific paperwork, including a Statement of Certifying Physician from your diabetes doctor, detailed foot examination notes from a podiatrist or qualified specialist, and a precise prescription for the therapeutic footwear. If any of these elements is missing, outdated, or lacks required information, your claim will likely be denied. To prevent this issue, request copies of all documentation to review before submission, ensuring all required fields are completed, signatures are present, and dates are current.

Using Non-Medicare Suppliers

Obtaining diabetic shoes from suppliers who aren’t enrolled in Medicare or don’t accept assignment will result in claim denial. Medicare will only cover therapeutic footwear from approved suppliers who have met their quality standards and agreed to accept Medicare’s approved payment amounts. Always verify a supplier’s Medicare participation status before proceeding with an order. The Medicare Supplier Directory available online or through 1-800-MEDICARE can help you confirm a provider’s enrollment status before your appointment.

The Appeal Process If Your Claim Is Denied

If your claim is denied, you have the right to appeal the decision through Medicare’s five-level appeal process. Start by carefully reviewing the denial notice to understand the specific reason for rejection. The first level involves requesting a redetermination, which must be filed within 120 days of receiving the denial notice. Include any additional documentation that addresses the stated reason for denial. Many appeals succeed at this first level when the appropriate supporting documentation is provided.

Medicare Appeal Success Tip: When appealing a denial, focus specifically on addressing the stated reason for rejection rather than submitting a general request for reconsideration. Include a cover letter that clearly references the claim number, summarizes your qualifying conditions, and explains how the additional documentation resolves the issues cited in the denial notice.

Get Your Medicare-Covered Diabetic Shoes This Year

Don’t wait for a foot crisis to occur before seeking the protective footwear you need. Medicare’s coverage for therapeutic shoes represents one of the most valuable preventive benefits available to beneficiaries with diabetes. Taking action now can protect your feet, maintain your mobility, and potentially prevent serious complications including hospitalization and amputation. Start by discussing therapeutic footwear with your diabetes doctor at your next appointment, then connect with a podiatrist who can evaluate your feet and document your qualifying conditions.

Frequently Asked Questions

Over years of helping patients navigate Medicare’s diabetic shoe benefit, I’ve encountered many common questions about coverage details and the procurement process. Here are answers to the questions I hear most frequently.

Remember that while these general answers apply to most situations, individual circumstances may vary. When in doubt, consult with your healthcare provider or contact Medicare directly for clarification about your specific case.

Who can I talk to to get more information?

You can always talk to the friendly and helpful diabetic shoe specialist at Advanced Health Pharmacy in Portage, Michigan. Stop in at the corner of Oakland and Centre in Portage or call 269-324-1100 during business hours or leave a message to get a call back. Check the bottom of the website for current days and times we are open.

How often can I get new diabetic shoes through Medicare?

Medicare covers one pair of therapeutic shoes and three pairs of inserts per calendar year. This benefit resets each January, meaning you can receive new footwear annually as long as you continue to meet the qualifying criteria. Your doctor must recertify your need each year, even if your foot condition remains unchanged. This annual renewal ensures your footwear remains in good condition and continues to provide the protection your feet need.

Will Medicare cover shoes for my spouse if they don’t have diabetes?

No, Medicare only covers therapeutic footwear for beneficiaries who have been diagnosed with diabetes and meet at least one of the qualifying foot conditions. If your spouse doesn’t have diabetes but needs specialized footwear for other reasons, they would need to explore different Medicare benefits that might apply to their specific condition.

Other Medicare coverage categories exist for orthopedic footwear related to certain conditions like severe arthritis or foot deformities from other causes. A podiatrist can help determine what Medicare benefits might apply to non-diabetes-related foot conditions.

Can I choose any style of diabetic shoe I want?

You can select from various styles of Medicare-approved therapeutic footwear, including casual, athletic, and dress shoes, but all must meet specific medical requirements based on your foot condition. The primary consideration will always be proper fit and therapeutic function rather than fashion. Modern diabetic shoes come in increasingly attractive designs that don’t look obviously medical, but certain style elements like very high heels or narrow toe boxes would compromise therapeutic value and wouldn’t be covered.

Work with your pedorthist or shoe fitter to find options that balance your personal preferences with your medical needs. Many suppliers offer catalogs or samples of different styles that meet Medicare’s requirements, allowing some personalization while ensuring proper foot protection.

Do Medicare Advantage plans cover diabetic shoes differently than Original Medicare?

Medicare Advantage plans must provide at least the same level of coverage for diabetic shoes as Original Medicare, but they may have different requirements regarding provider networks or prior authorization. Some Advantage plans might even offer enhanced coverage with lower out-of-pocket costs or additional pairs of inserts. Contact your specific Medicare Advantage plan to understand their exact coverage details, approved suppliers, and any prior authorization requirements before beginning the process.

Keep in mind that while Advantage plans can’t offer less coverage than Original Medicare for diabetic shoes, they can implement different processes for accessing the benefit. Following your plan’s specific procedures helps ensure successful coverage and minimize out-of-pocket expenses.

What happens if my feet change size after I receive my Medicare-covered shoes?

If significant changes occur in your foot size or condition after receiving your Medicare-covered shoes, contact your podiatrist or the prescribing physician. Medicare may cover replacement shoes within the same calendar year if there’s a documented medical necessity due to changes in foot dimensions or condition that make your current therapeutic footwear unsuitable or unsafe. Your doctor will need to provide detailed documentation explaining why new footwear is medically necessary before the standard 12-month replacement cycle.

Foot changes can occur rapidly with diabetes, especially with conditions like Charcot arthropathy or following partial amputation. Don’t continue wearing shoes that no longer fit properly, as ill-fitting therapeutic footwear can cause harm rather than protection. Always consult your healthcare provider promptly if you notice changes in how your shoes fit.

Maintaining proper foot health requires vigilance and appropriate care, including wearing properly fitted therapeutic footwear. Medicare’s coverage for diabetic shoes provides essential protection against serious complications, but you must take the initiative to access this valuable benefit. With the right documentation and by following the proper procedures, you can obtain the specialized footwear you need to keep your feet healthy and maintain your mobility and independence.