Does Medicare Cover Orthotics?

An orthotic is a device used for supporting or treating injured or weakened muscles, joints and bones.

While orthotics are often associated with shoe inserts, there are several types to treat a variety of ailments.

Orthotics are considered part of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). This means that some of their costs are covered by Medicare.

Therapeutic shoes and inserts have several uses. They are commonly used to support and protect the foot and can also alleviate pain. Inserts work by keeping too much pressure from impacting any one spot of your foot as you walk.

They can be used to treat many different issues, including loss of sensation, foot or toe deformities and plantar ulceration.

But therapeutic shoes and inserts are only covered under Medicare Part B if you have diabetes and severe diabetic foot disease.

Medicare will cover 80% of the costs for therapeutic shoes and inserts. That leaves you responsible for 20% after your deductible has been met. The Medicare Part B deductible for 2024 is $240. Your doctor and supplier must be enrolled in Medicare.

The doctor who treats you for diabetes needs to deem the shoes or inserts medically necessary. They then must be prescribed by a qualified health care professional.

Braces and supports are used to correct injuries, help stability and ease pain. They decrease the chance of additional injury and can also be used to help deformities.

Braces may be used as an alternative to surgery for some injury cases. There are some potential downsides to using braces, as they can result in loss of muscle function over time.

Braces must be deemed medically necessary by a health care professional. If they are, then Medicare will cover 80% of the cost. That leaves you with 20% after you’ve paid your deductible.

These types of braces and supports are also part of the DMEPOS Competitive Bidding Program. If you live in a competitive bidding area, you will need to make sure you are using a contract supplier in order for Medicare to help pay for an off-the-shelf back or knee brace.