MEDICARE THERAPEUTIC SHOE PROGRAM

In an effort to prevent foot ulcers in people with diabetes who are at risk, Medicare will help pay for therapeutic shoes. For those who qualify, Medicare will pay 80 percent of the allowed amount for one pair of shoes and up to three pairs of molded innersoles per year. (The allowed amount varies, depending on the kind of footwear you need.) Most secondary insurers will help pay the other 20 percent.

Who Qualifies?

Not everyone with diabetes needs special shoes. To qualify, you must be under a comprehensive diabetes treatment plan and have one or more of the following:

• Partial or complete amputation of the foot
• Previous foot ulceration
• History of preulcerative callus
• Peripheral neuropathy with evidence of callus formation
• Foot deformity
• Poor circulation

Who Does NOT Qualify?

People with diabetes who do not have one of the above conditions. It is not enough to just have diabetes.

What Paperwork is Required?

The physician treating you for your diabetes must certify that you have diabetes, that you have one or more foot problems just mentioned, that you are under a comprehensive diabetes treatment plan, and that you need special shoes. Medicare has a form for this certification. You will also need a prescription for the shoes.

Who Prescribes the Shoes?

A prescription is required from a podiatrist or physician who knows how to fit shoes and inserts for people with diabetes. The prescription should indicate a particular type of footwear, such as shoes, inserts, or modifications.

Who Supplies the Shoes?

The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a pedorthist, orthotist, or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a defined rural area or area where there is a shortage of heath professionals. The prescribing podiatrist may be the supplier.

What Do You Get?

Coverage is limited to one of the following per calendar year:

• One pair of off-the-shelf extra-depth shoes and three additional pairs of special inserts that your podiatrist will select for you. Extra-depth shoes have room to accommodate innersoles or orthotics.
• One pair of off-the-shelf extra-depth shoes including a modification, and two additional pairs of special inserts.
• One pair of custom-molded shoes and two additional pairs of special inserts.

I Have Diabetes and Need Special Shoes. Why Shouldn't I Get Them Free From Medicare?

Remember, there is no such thing as a free lunch -- and there is no such thing as a free pair of shoes. There are over 16 million people with diabetes in the United States. Many of them are of Medicare age. If every Medicare beneficiary with diabetes gets special shoes, there will be no money left for other important aspects of the Medicare program. If we abuse the shoe benefit, Medicare suffers -- and everyone who depends on Medicare will suffer as well.
------------------------------------
This patient Information Guide first appeared in PRACTICAL DIABETOLOGY, September 2004, copyright (c) 2004 R.A. Rapaport Publishing, Inc., New York, NY. Reprinted with permission.