Our feet are an important part of the body. They allow us to easily get around, so it’s equally important to take care of them. If you’re enrolled in Medicare, you may receive some foot care coverage. The differences between routine foot care (podiatry) and medically necessary foot care can define what coverage may be available to you and what you may end up owing.
Routine Podiatry
Routine podiatry, or foot care, generally refers to day-to-day maintenance and care you may receive or even give yourself. This can include trimming or clipping toenails, removing calluses or corns, and soaking your feet to prevent future issues. Generally, these are things you can do at home or without an expert’s aid. For this reason, routine podiatry services aren’t covered by Original Medicare. This means that you’ll be expected to pay the full amount for these services, unless you’re told otherwise by the Medicare program or your podiatrist.
For this reason, routine podiatry services aren’t covered by Original Medicare.
Medicare Advantage usually doesn’t cover routine podiatry either, which can leave you in a bit of a pickle should it be something that you want to have done and can’t afford on your own. Your one possible avenue for coverage in this situation is to receive a referral from your primary care physician. While this is no guarantee that you’ll receive coverage — and it’s absolutely something you should check before receiving the care — it could potentially increase your chances of receiving coverage.
Diabetes and Foot Exams
Diabetes and foot concerns often go hand-in-hand, making podiatry that much more important to your health. Diabetes can cause nerve damage in your lower legs, which can increase your risk of needing that limb amputated. To prevent this, Original Medicare can cover an annual foot exam with a podiatrist. Exams are covered as long as you have diabetes-related lower-leg nerve damage that can increase your risk of amputation and haven’t seen a foot doctor since your last annual foot exam.
Since Medicare Part B would likely cover the exam, you’d owe 20 percent of the Medicare-approved amount.
If you do utilize Medicare insurance coverage for a diabetes-related foot exam, you will still have some out-of-pocket costs. Since Medicare Part B would likely cover the exam, you’d owe 20 percent of the Medicare-approved amount and the Part B deductible also applies. If you receive the care in a hospital outpatient setting, you’d owe a copayment.
Injury or Disease
Original Medicare will also usually cover podiatry if it is medically necessary. This coverage can extend to exams, diagnosis, and treatment for foot injuries and diseases like, hammer toe, bunions, and heel spurs.
In terms of coverage, Original Medicare will pay 80 percent of the federally approved amount for medically necessary foot care.
The Medicare program’s coverage of medically necessary foot care is similar to their podiatry coverage for diabetes. First, you must meet your Part B deductible, since that will apply. In terms of coverage, Original Medicare will pay 80 percent of the federally approved amount. This leaves you to pay the remaining 20 percent out of pocket. You will owe a copay if you receive the treatment in a hospital outpatient setting.
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We’ve mostly spoken about Original Medicare coverage, and that’s for a good reason. Medicare Advantage plans cover at least what Original Medicare covers, so you can count on at least that being covered for you. Some Medicare Advantage plans may offer additional coverage, though this is specific to each plan. If you’re interested in seeing your options, check out Shop & Enroll’s Plan Finder tool, which shows you plans in your area and allows you to compare them.
Very few things in this world come free. Thankfully, since Medicare insurance can offer some coverage for certain podiatry services, you may have more affordable treatment options for your feet.
