Does Medicare cover podiatry? What’s covered, what isn’t and costs

What does Medicare cover for podiatry?

A podiatrist is a doctor who specializes in the foot and ankle. Medicare Part B, the part of Medicare that covers doctor visits and outpatient care, pays for podiatry when it’s medically necessary: you have an injury, infection or foot condition that needs to be diagnosed or treated. You don’t need a referral with Original Medicare.

Medicare’s own summary is on its foot care coverage page.

Does Medicare cover routine foot care like toenail trimming?

Usually not. Medicare generally doesn’t pay for:

• trimming, cutting or clipping toenails
• cutting or removing corns and calluses
• hygiene and preventive care, such as cleaning or soaking your feet

If you get these services without a qualifying condition, you pay the full cost.

When Medicare does pay for routine foot care

Medicare can cover routine foot care if you have a medical condition that affects the nerves or blood flow in your legs and feet, such as diabetes with nerve damage or peripheral artery disease (poor circulation in the legs). With these conditions, a small nick from a nail clipper can turn into a wound that’s slow to heal, so it’s safer for a professional to do it.

To qualify, your podiatrist has to find and document signs that make routine care risky for you, such as loss of feeling, weak pulses in the feet or skin and nail changes from poor circulation. Medicare pays only at set intervals, not every time you’d like your nails trimmed. Your podiatrist may ask for the name of the doctor who treats your diabetes or circulation problem and when you last saw them, so bring that with you.

Thick, painful fungal nails are a separate case. Trimming and thinning them can be covered when they cause pain, infection or trouble walking. Learn more about nail care at Evolve Health.

If Medicare might not pay: your podiatrist’s office may ask you to sign a form called an Advance Beneficiary Notice before a service. It tells you Medicare may not cover it and what it will cost, so you can decide whether to go ahead.

Diabetic foot care under Medicare

Medicare gives people with diabetes extra foot care coverage, because diabetes raises the risk of foot ulcers, infections and amputation.

Foot exams every 6 months

If you have diabetic peripheral neuropathy with loss of protective sensation (nerve damage that means you can’t feel light pressure on your feet), Part B covers a foot exam and treatment every 6 months, as long as you haven’t seen a foot care professional for another reason in between. The visit can include care for calluses, nails and ulcers, depending on what the exam finds. Details are on Medicare’s foot care for diabetes page.

Even if you don’t qualify for the 6-month exam, everyone with diabetes should have their feet checked at least once a year, and more often with numbness, poor circulation or a past foot ulcer. Our guide to diabetic foot care explains what the exam checks.

Therapeutic shoes and inserts

If you have diabetes and certain foot problems, Part B helps pay for therapeutic shoes. Each calendar year it covers either:

• one pair of extra-depth shoes and three pairs of inserts, or
• one pair of custom-molded shoes and two extra pairs of inserts.

To qualify, the doctor who treats your diabetes has to certify that you have diabetes and at least one of these: a past foot ulcer, calluses that could lead to ulcers, nerve damage with calluses, poor circulation, a foot deformity, or a partial or full foot amputation. A podiatrist or other qualified doctor prescribes the shoes, and a supplier enrolled in Medicare fits them. See Medicare’s therapeutic shoes page.

Does Medicare cover orthotics and braces?

Medicare generally doesn’t cover foot orthotics or arch supports on their own, whether store-bought or custom. The main exception is the inserts that come with diabetic therapeutic shoes. Part B does help pay for leg and ankle braces when a doctor orders them for a medical need, and the supplier has to be enrolled in Medicare. If orthotics could help your foot pain, our guide to whether you need orthotics explains the options, including lower-cost store-bought supports.

What does podiatry cost with Medicare?

With Original Medicare:

• You pay the yearly Part B deductible first. The amount changes every year, and Medicare.gov lists the current figure.
• After that, you usually pay 20% of the Medicare-approved amount for each covered service.
• If you’re seen in a hospital outpatient department, you may also pay a facility copayment.
• A Medigap (Medicare Supplement) policy can pay some or all of your 20%, depending on the plan.
• You pay the full cost of services Medicare doesn’t cover, such as routine nail care without a qualifying condition.

Ask whether the podiatrist accepts assignment. A provider who accepts assignment agrees to take the Medicare-approved amount as full payment, so you pay only your deductible and 20%. A provider who doesn’t can charge up to 15% more than the approved amount.

With a Medicare Advantage plan, you pay the plan’s specialist copay or coinsurance instead, and your yearly out-of-pocket costs have a limit.

Original Medicare vs Medicare Advantage for podiatry

Medicare Advantage plans (Part C) are sold by private companies approved by Medicare. They must cover everything Original Medicare covers, but they run it their own way.

If you have a Medicare Advantage plan, see our guides for Humana, UnitedHealthcare and AARP and Aetna plans.

Does Evolve Health accept Medicare?

Yes. This is what our insurance list shows today:

This table is for podiatry. For physical therapy and nephrology at our Florida offices a few plans differ (CarePlus, for example, is not accepted for physical therapy), so check the column for your service on our insurance list. Acceptance can vary by state, office, provider and plan type, and Medicare Advantage networks change from year to year. Our team verifies your benefits before your visit and tells you your options, and the estimated cost, if anything isn’t covered. If you also have Medicaid, call before booking, because Medicaid rules affect where you can be seen.

How to find a podiatrist who accepts Medicare

• Original Medicare: search for podiatrists near you with Medicare’s Care Compare tool, and ask the office whether they accept assignment.
• Medicare Advantage: use your plan’s provider directory, or call the member services number on your plan card, and check whether you need a referral.
• Either way, confirm with the podiatry office when you book, because networks change.

What to bring:

• your Medicare card, or your Medicare Advantage plan card if you have one (use the plan card instead of your red, white and blue Medicare card)
• your Medigap or other secondary insurance card
• a photo ID
• a list of your medicines and allergies
• the name of the doctor who treats your diabetes or circulation problem, and when you last saw them
• the shoes you wear most

When not to wait

Go to the emergency room if your foot suddenly turns cold, pale or blue, a bone is showing or your foot looks deformed after an injury, or you have spreading redness with a fever.

Get seen the same day if:

• you have diabetes and notice a new sore, blister or color change, even if it doesn’t hurt
• your foot is red, hot and swollen
• you can’t put weight on your foot after a fall or injury

Book a regular visit if foot pain lasts more than a week or two, you have numbness or tingling in your feet, or you have diabetes and haven’t had a foot exam this year.

Booking a podiatrist with Medicare

You can find an Evolve Health podiatrist near you and book online, or choose an office from our locations. Have your Medicare or plan card handy: the team checks your coverage, and any referral your plan needs, before your visit is confirmed. Questions first? Call 844-663-3769.