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.
