â€œFoot careâ€ can refer to treatment for serious conditions that affect the health of your feet or everyday concerns like calluses. Medicare separates these two kinds of foot care and only covers treatments that are medically necessary.
In most cases, Medicare doesnâ€™t pay for routine foot care that isnâ€™t related to a serious medical condition. However, you might have additional coverage for foot care if you have a Medicare Advantage plan.
This articles explains the parts of Medicare that pay for foot care, which medical conditions are covered, out-of-pocket costs, and more.
What kind of foot care does Medicare cover?
Medicare covers foot care that is considered medically necessary. For care to be considered medically necessary by Medicare, it needs to be prescribed by a physician or other licensed medical professional. Generally, Medicare will cover services you receive from a qualified podiatrist, although care from other physicians and providers might also be covered in some cases.
When you receive medically necessary foot care as an outpatient, it will be covered under Part B. Some examples of foot care that would be considered medically necessary include treatment of:
- infected nails
- hammer toe
- heel spurs
If you receive foot care while youâ€™re admitted to the hospital, it will be covered under Part A. Just like with Part B coverage, the foot care you receive in the hospital must be considered medically necessary to be covered.
No matter where you receive your foot care, it will need to be performed by a Medicare-approved provider to qualify for coverage.
Does Medicare Part C cover more foot care?
You might have additional foot care coverage depending on your Part C, or Medicare Advantage, plan. Medicare Advantage plans are required to cover all of the same services as parts A and B.
In many cases, Medicare Advantage plans offer additional coverage, which could include routine foot care. Check with your plan for specific coverage details before you go to your foot care appointment.
What types of foot care are not covered?
Routine foot care is not covered by Medicare. Routine foot care includes services such as treatment for flat foot or fittings for orthopedic shoes, when those services are not medically necessary. Routine foot care also includes hygiene and upkeep services such as:
- nail trimming
- treatment of calluses
- removal of dead skin
- foot soaks
- application of lotions
Keep in mind that this applies to Medicare parts A and B, whatâ€™s known as â€œoriginal Medicare.â€ A Medicare Advantage plan might offer coverage for some of these services, including orthopedic shoes.
What is covered for diabetic foot care?
Medical necessity of diabetic foot care
Some of Medicareâ€™s foot care rules are different if you have have diabetes. This is because diabetes can lead to an increased risk of serious foot problems.
Many issues are caused by nerve damage called neuropathy. Over time, this nerve damage can cause you to no longer feel any sensation in your feet. This can make it difficult to know if youâ€™ve injured your foot or have a wound. People with diabetes are also susceptible to skin damage and ulcers, which can become infected.
Additionally, diabetes can affect your circulation and reduce the blood flow to your ankles, feet, and toes. Together, all these factors can lead to serious infections that could eventually result in the need for a foot amputation. For this reason, Medicare considers foot care medically necessary for people with diabetes.
Covered services and equipment
People with diabetes are covered by Medicare Part B for foot care services including:
- nail care
- removal of calluses and corns
- specialized shoes and inserts
Youâ€™ll need a diagnosis of diabetic neuropathy to have these services covered by Medicare. You can receive a foot evaluation and care once every 6 months.
If your podiatrist recommends it, you can be covered for one pair of custom- molded or extra-depth shoes each year, too, including the fitting appointments. Medicare will also pay for inserts to help your regular shoes provide the right support. If you prefer inserts instead of therapeutic shoes, you can get two pairs of custom-molded inserts or three pairs of extra-depth inserts each year.
How do I qualify for these benefits and what rules apply?
Your condition needs to be under treatment by a physician to qualify for coverage. Your healthcare provider will need to show documentation that youâ€™re receiving treatment for a condition that requires foot care. Youâ€™ll need to be receiving active care for 6 months for that condition for Medicare to begin paying.
Make sure youâ€™re enrolled in either Medicare Part B or a Medicare Advantage plan. Medicare Part A only covers hospital and long-term care expenses. Your podiatrist or other foot care provider will need to be enrolled in Medicare and accept assignment. If youâ€™re using a Medicare Advantage plan, you might need to use a provider whoâ€™s in your planâ€™s network.
What costs should I expect?
Your costs will depend on whether you have original Medicare or a Medicare Advantage plan.
Under original Medicare, youâ€™ll pay 20% of the Medicare-approved cost for services once you meet your deductible. In 2020, the Part B deductible is $198 for most people.
Once youâ€™ve met your deductible, Medicare will pay for 80% of all foot care services and medical equipment, including diabetic footwear, considered medically necessary. Youâ€™ll also need to pay the Part B premium. Most people will pay a premium of $144.60 per month in 2020.
You can search for the Medicare-approved costs of foot care in your area on the Medicare website.
Part C (Medicare Advantage)
When you use a Medicare Advantage plan, the costs will vary depending on your planâ€™s rules. You might have different coinsurance costs, a different deductible amount, or a different monthly premium. You might also need to stay in-network to avoid higher costs.
If your Advantage plan offers additional coverage for foot care beyond original Medicare, these costs will be outlined in your plan details.
You might also be wondering if Medigap plans offer any additional cost savings. Unfortunately, these plans do not provide added benefits for foot care. However, Medigap plans might pick up some of the coinsurance or other out-of-pocket costs leftover from your Part B coverage.
If you have Medicare and need foot care, keep these points in mind:
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