Medicare and Podiatry

Medicare and Podiatry how are you covered?

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Podiatrists are doctors who specialize in conditions pertaining to feet and ankles. They can treat anything as simple as an ingrown toenail to plantar fasciitis. Aging adults are prone to chronic foot problems, especially if they have an underlying disease such as diabetes.

However, Medicare doesn’t cover all podiatry services. In fact, Medicare doesn’t cover routine foot care at all. For other podiatry services such as treating specific conditions and surgeries, Medicare has specific rules for coverage. First, let’s discuss what isn’t covered by Medicare.

Podiatry Services Not Covered by Medicare

Medicare doesn’t cover routine foot care except in situations where another health condition requires it, such as diabetic neuropathy. Routine foot card includes, but is not limited to, corn removals, debriding toenails, and maintenance care. Another condition that Medicare doesn’t cover any podiatry services for is flat foot.

Medicare also doesn’t cover supportive devices such as orthopedic shoes unless they are included in the price of a leg brace or the patient has diabetes. Medicare doesn’t cover these services because they are not considered medically necessary.

Podiatry Services That May be Covered by Medicare

Medicare will cover podiatry services that are considered needed to diagnose or treat a medical condition. Conditions such as hammer toes, heel spurs, and bunion deformities yield Medicare coverage for treatment.

Diabetes patients get a little more leeway when it comes to foot care because they have a greater risk of developing foot conditions. Therefore, if you have diabetes, you can receive a foot exam once every six months as long as you have been to a podiatrist for any other reason within those six months.

As we briefly mentioned above, Medicare will also cover services that are otherwise considered routine if you have an underlying disease. For instance, if you have peripheral vascular disease, a disease that reduces blood flow to your feet and other limbs, routine podiatry services may be covered. Other diseases and conditions that may validate routine foot care coverage are Buerger’s disease, peripheral neuropathies, and Arteriosclerosis obliterans.

Mycotic nails can be common in the aging community. Mycotic nails are nails that are yellow-brown in color, with a thick and brittle texture, and are usually infected with fungus. Medicare may cover treatment for mycotic nails if your doctor documents clinical evidence of infection, and you are showing symptoms such as pain or secondary infection.

How You’ll Pay for Your Podiatry Services Through Medicare

Podiatry services are usually performed in a doctor’s office in an outpatient setting. Medicare Part B covers medically necessary outpatient doctor services and therefore, will be in charge of your podiatry services.

Part B will pay 80 percent of your medical costs. You will be responsible for both an annual deductible of $185 and 20 percent of the bill. If you receive any treatments in a hospital as an outpatient, you will likely experience a copay as well.

If you ever require surgery to treat a foot condition and you are admitted in the hospital on an in-patient status, Part A will come in effect as well. You will have a $1,364 deductible for your hospital stay that will pay for your hospital services such as your room and meals.

This deductible will also cover your first 20 days in a skilled nursing facility (SNF) if your doctor recommends you finish your recovery there. Medicare will only cover your SNF stay if you were admitted to the hospital for at least 3 days.

When you apply for Medicare, you may want to consider supplemental coverage to help pay for things like this. Medicare plans such as Medigap and Medicare Advantage can help lower some of these costs. Medigap plans can help cover your Part A deductible and Part B deductible, copays, and coinsurance.

Medicare Advantage plans can help lower your out-of-pocket costs by setting a copayment amount that may be lower than your normal Part B coinsurance. Medicare Advantage plans also often offer extra podiatry services, such as routine foot care exams.

In summary, Medicare will cover podiatry services as long as they can be deemed medically necessary. If you’re unsure about whether your specific service will be covered, ask your podiatrist.