How Does Medicare Cover Podiatry?

Our feet are made of a complex structure of 26 bones and 33 joints. There are a myriad of issues that might come up in your lifetime – bunions, plantar fasciitis, osteoarthritis, diabetic complications, and so on. Foot pain is a common problem for older adults, leaving many people to wonder if Medicare covers foot care.

Podiatry is a word used to reference all kinds of foot care services. It could refer to things as simple as therapeutic inserts or shoes, or include more major treatment services such as severe diabetic foot disease. Whether Medicare covers podiatry depends on what services you require. Let’s talk about a few common concerns most Medicare beneficiaries have.

Will Medicare Cover a Podiatrist?

Before we get into the specifics, understand that your benefits will depend on what kind of Medicare plans you have. You could have Medicare only (Parts A and B), you may have a Medicare Supplement (Medigap) plan, or you could be enrolled in Medicare Advantage (Part C). For our purposes today, we’re going to talk about Original Medicare only. If you have a Medicare Advantage plan, you’ll need to consult your plan’s summary of benefits. However, a Part C plan offers at least as much coverage as Parts A and B.

If you need to see a podiatrist, you may or may not have coverage under Medicare Part B. (Part A is for inpatient services only.) It really boils down to what foot care services you need.

If the care you need is medically necessary, like to treat an injury or disease, Part B will offer some assistance. It may even include coverage for therapeutic shoes and inserts if you have diabetes and are diagnosed with severe diabetic foot disease. Part B may also cover annual foot exams if your problems are caused by diabetes. It may also cover medically-necessary treatments like hammer toe, heel spurs, and bunion deformities.

To be considered for coverage, you must have gotten a referral from your primary care doctor to a podiatrist. If Part B does approve the services, you’ll need to pay your annual deductible and then about 20% of the cost. (Remember, if you have a Medicare Supplement or Medicare Advantage plan, your cost-sharing will be different.) In addition, your cost could be different if your podiatrist does not accept Medicare assignment, and you may have a copay due at the time of service.

Coverage will also be considered for tests your podiatrist recommends, such as laboratory tests, x-rays, physical therapy, prescription medications, or durable medical equipment.

Podiatry Services Not Covered by Medicare

Medicare Part B does not typically include benefits for routine foot care services like corn removal, callus trimming, or the debridement of toenails. However, if any of these services are performed as part of other medically-necessary treatment, they may also be covered. In addition, Medicare will consider covering services if there is a system condition present, or if the toenails are infected.

No one likes surprise medical bills. As confusing as it can be, you’ll want to take the time to find out if Medicare covers podiatry when you need those services. Many times, asking your healthcare provider will give you the answers you need. Or, you can call the Medicare advisors at Bobby Brock Insurance. We can help you determine if your services are covered and if there is a plan that may offer the benefits you need. Call today to speak to a licensed insurance agent.