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Diabetic on Medicare? You may be eligible for coverage of shoes and inserts.
The Truth Behind the Medicare Therapeutic Shoe Program
“My friend gets a free pair of shoes from Medicare every year. Why can’t I?”
The Medicare Therapeutic Shoe Program was put in place by CMS to address the growing rate of wound care and foot amputations by people who suffer from diabetes. So, the program is all about saving feet and saving the government money by reducing the occurrence of wound care and limb amputations.
First, you should know that the shoes are NOT FREE. By law, Medicare pays 80% of the cost of shoes and inserts for eligible diabetics and the patient is required to cover the 20% co-pay. You must be signed up for Medicare Part-B to qualify. Many times your secondary insurance will cover the 20% and that’s why most people consider the shoes and inserts as “free” since there is no out-of-pocket cost when the secondary insurance coverage applies. If you have not met your annual Medicare deductible, you may be required to pay the balance to the facility or doctor when your shoes and inserts are dispensed.
Some insurance companies have programs where they act as Medicare (Medicare Advantage, Secure Horizons) and all the billing goes through them for your convenience. Also, be aware that HMO’s dictate where you may get your diabetic shoes to qualify for complete coverage. If you have an HMO like those mentioned above, you may get your shoes and inserts from one of their approved providers.
Now that you understand the ins and outs on the insurance end you’re ready to go shoe shopping. But just because you are diabetic doesn’t mean you are entitled to shoes! As mentioned earlier, the whole purpose of the program is to help you AVOID wound care or foot amputation. Therefore, in order to qualify for the diabetic shoes and inserts, the physician who treats you for your diabetes (M.D or D.O), must certify that you are under their care for diabetes by completing a Statement of Certifying Physician Form and stating that you have at least one of the following conditions: 1) History of partial or complete foot amputation, 2) History of previous foot ulceration, 3) History of pre-ulcerative callus, 4) Peripheral neuropathy with evidence of callus formation, 5) Foot deformity or, 6) Poor circulation.
If you also are being treated by a podiatrist (DPM), the podiatrist can write the prescription for shoes and inserts for you but you must still have a Statement of Certifying Physician from the doctor who monitors your diabetes.
If you are eligible, you are entitled to one pair of Medicare approved extra depth shoes and three pair of heat-molded multi-density inserts per calendar year. The inserts are an integral part of the program and must be dispensed with the shoes. Custom molded inserts may be substituted for heat molded inserts should your physician decide it’s necessary. The same goes for custom molded shoes. If your physician tells you diabetic inserts aren’t necessary, it’s time to start asking questions. The purpose behind the inserts is to provide support, cushioning and a neutral surface so the clinician and patient can easily spot excessive pressure points or even worse, an active ulcer. Without the inserts, you’ve defeated the purpose of the program and more importantly, proper diabetic foot care.
To make sure you are being treated properly, get fitted by a podiatrist (DPM) or certified pedorthist (C.Ped). In fact, Medicare announced recently that by September, 2009, only physicians and accredited facilities may fit and dispense diabetic shoes. This is good news for you, the consumer, as the so-called fly-by-night mail order houses providing diabetic shoes, without regard to proper fit and follow-up for your well being will have a difficult time doing business. Note that Foot Solutions - Richardson/Garland is a Board of Certification/Accreditation (BOC) Accredited Facility.
In terms of fit and style, diabetic shoes are required to have extra-depth built in to accommodate various insoles. The minimum thickness of the diabetic insert is 5/16”. Therefore, shoe depth is achieved by adding material to the upper and equipping the shoe with a removable factory insole. A real diabetic shoe has a seamless lining and is available in at least three widths with a lace, Velcro or buckle option. Manufacturers list the shoes and inserts as SADMERC approved, meaning the shoe meets the fitting standards set forth by Medicare and are eligible for insurance reimbursement.
Diabetic shoes do not need to be unattractive. With over 20 million people diagnosed with diabetes, shoe manufacturers recognize that style is becoming more important. Today, you can find diabetic shoes in various categories like athletic, casual, dress and work boots in many styles and colors. But again, the objective is to protect the feet, not win a fashion contest.
To learn more about diabetic shoes and the many styles available, visit any one of these web sites. www.foot.com or www.pwminor.com
Remember, as a diabetic, taking care of your feet is taking care of you!
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