Does Medicare Cover Orthotics?
Orthotics are devices used to treat injured muscles and joints. Medicare will typically cover 80% of the costs for orthotic devices under Medicare Part B if they are deemed medically necessary by a doctor. You are still responsible for 20% of the cost after you meet your deductible.
- Written by Christian Simmons
Christian Simmons
Financial Writer
Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.
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Matt Mauney
Matt Mauney
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Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
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Aflak Chowdhury
Aflak Chowdhury
Medicare Expert
Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.
Read More- Published: April 26, 2021
- Updated: October 20, 2023
- 4 min read time
- This page features 7 Cited Research Articles
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Orthotics Coverage at a Glance
| Medicare Plan | Orthotics Coverage |
|---|---|
| Part A (Inpatient) | N/A |
| Part B (Outpatient) | Covers 80% of the costs for therapeutic shoes and inserts only if you have diabetes and severe diabetic foot disease and have reached your Part B deductible. |
| Part C (Medicare Advantage) | Coverage mirrors Part B. Select plans may offer additional benefits. |
| Part D (Prescription Drugs) | N/A |
| Supplemental Insurance | Can help cover out-of-pocket costs of custom orthotics. Coverage varies by plan. |
What Is an Orthotic Device?
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.
- Therapeutic shoe inserts
- Custom-molded shoes
- Extra-depth shoes
- Arm braces
- Leg braces
- Neck braces
- Back braces
Orthotics are considered part of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). This means that some of their costs are covered by Medicare.
Medicare Coverage of Therapeutic Shoes and Inserts
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.
- One pair of custom-molded shoes and inserts
- One pair of extra-depth shoes
- Two extra pairs of inserts for custom-molded shoes
- Three extra pairs of inserts for extra-depth shoes
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 2025 is $257. 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.
- Orthotist
- Pedorthist
- Podiatrist
- Prosthetist
- Other qualified professional
Medicare Coverage of Braces and Supports
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.
- Arm braces
- Leg braces
- Neck braces
- Back braces
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.
Commonly Asked Questions About Medicare and Orthotics
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- Certified educator in personal finance
- Bachelor’s degree in journalism from the University of Central Florida Burnett Honors College
- Master’s degree in integrated business from the University of Central Florida
7 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2023, October 12). 2024 Medicare Parts A & B Premiums and Deductibles. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
- U.S. Centers for Medicare & Medicaid Services. (2022, January). Your Medicare Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/10116-your-medicare-benefits.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Therapeutic shoes & inserts. Retrieved from https://www.medicare.gov/coverage/therapeutic-shoes-inserts
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Braces (arm, leg, back, and neck). Retrieved from https://www.medicare.gov/coverage/braces-arm-leg-back-neck
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What Part B covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-b-covers
- Health Resources & Services Administration. (2017, April). Orthotics. Retrieved from https://www.hrsa.gov/hansens-disease/diagnosis/orthotics.html
- University of Maryland Medical Center. (n.d.) A Patient’s Guide to Back and Neck Braces. Retrieved from https://www.umms.org/ummc/health-services/orthopedics/services/spine/patient-guides/braces
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