People with injuries, bone changes, or certain medical conditions may require specialized foot care. Medicare covers any medically necessary treatment that a doctor or approved healthcare provider administers.
Medicare recognizes the need for adequate foot care to reduce the potential for hospitalization and infection and to improve quality of life. For example, people who have lost sensation in the foot due to nerve damage are at risk of injury.
This article will discuss the types of foot care a person may need, types of Medicare coverage, and the parts of Medicare that may cover foot care.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part A may cover treatment that a person receives during an inpatient stay in a hospital, providing it is medically necessary.
Part A may also cover recommended surgical procedures to correct a foot problem.
Medicare Part B covers outpatient care, including cover for a podiatrist to evaluate and treat conditions at their office. For example, treatment could be for a foot injury, foot infection, or diabetes.
Part B also pays for medically necessary care related to foot changes such as:
- heel spurs
- plantar warts
- fungal nails with pain or a secondary infection
Medicare Part C, also known as Medicare Advantage, combines the benefits of parts A and B into one policy. Private insurance companies administer Medicare Advantage plans.
Sometimes, a person with a Medicare Advantage plan may need to use an in-network healthcare provider. This can help keep costs to a minimum.
Medicare pays for services, items, and tests that are medically necessary in order to maintain good health.
Foot care services that Medicare may not cover include:
- cutting or trimming of the nails (except for people with diabetes who have thick nails)
- removing corns and calluses
- foot soaks or preventive care
A person who receives foot care from a podiatrist or other approved healthcare provider may have some out-of-pocket costs to pay.
If a doctor recommends a surgical procedure, gaining prior approval for the surgery can reduce a person’s out-of-pocket expenses, as this can manage coverage expectations.
Part A has a deductible of $1,408 per benefit period. There is no copayment for the first 60 days a person stays in the hospital.
Part B has an annual deductible of $198. This amount is correct in 2020, but it may change each year. A person may also pay a copayment for each service.
After paying the deductible in full, a person will pay a 20% coinsurance. Medicare pays the remaining 80% of approved costs.
Some Medicare Advantage plans offer more benefits than original Medicare and may help pay for routine foot care. A person can contact their plan provider to ask about their benefits.
Out-of-pocket costs can vary among private insurance companies, but most Medicare Advantage plans put a cap on out-of-pocket expenses.
People with original Medicare may also have a Medigap policy. This is another type of plan that private insurance companies administer.
Medigap plans help cover the gaps in coverage from parts A and B, such as deductibles, coinsurance, and copayments.
People who are newly eligible for Medicare after January 1, 2020, are no longer able to purchase a Medigap plan that covers the Part B deductible. However, if a person already has this coverage, they can keep it.
There are several types of foot care, but Medicare does not pay for all of them.
Some of the most common types are:
- Care for athlete’s foot: This is a fungal infection on the foot that usually starts between the toes.
- Care for hammertoe, bunions, and heel spurs: These are changes to the bones that may require surgery. A doctor may also prescribe special shoes to reduce the pain.
- Care for corns and calluses: These are characterized by a buildup of extra layers of skin on areas that receive a lot of friction. Wearing poorly fitting shoes can cause these changes.
- Care for ingrown nails: These occur when the skin grows over the edge of a nail or a nail grows into the skin and causes infection. Causes can include cutting the toenail incorrectly, wearing poorly fitting shoes, having a fungal infection, or having an irregular foot structure.
- Care for fungal nails: Nails can become infected with a fungus when the foot stays damp. This may occur if a person wears socks for extended periods and does not let the foot dry completely.
- Care for plantar warts: These are small, noncancerous growths that develop due to a virus growing on the ball of the foot.
- Pedicures: This is a cosmetic treatment that people can carry out on the toenails.
Diabetes can cause nerve damage in the feet. This is called diabetic neuropathy. The condition can lead to a loss of sensation in the feet, resulting in a higher risk of injury.
Diabetic neuropathy can also affect blood flow, which can contribute to poor wound healing, leading to infection and, in severe cases, amputation.
By scheduling regular checkups and checking the feet daily, a person can ensure that their foot health remains well-managed.
A person with Medicare may have other options that could help pay for foot care. These include:
- Medicare savings programs: These are state-run programs that help pay deductibles, coinsurance, and copayments.
- Program of All-Inclusive Care for the Elderly (PACE): This is a community-based program for people with Medicare or Medicaid.
- Extra Help: This is available to those with Medicare Part D prescription drug plans. It helps pay for prescribed medications.
- Supplemental Security Income: This provides benefits for adults with disabilities and families with limited income.
Foot care is essential for people to maintain their mobility and independence. Medicare pays for any medically necessary treatment that a doctor or other approved healthcare professional provides.
A person with a foot injury or changes such as heel spurs or bunions is usually eligible for coverage. People with diabetes also need special foot care to reduce the risk of infections and injuries.
Additional help may be available from programs such as PACE or Medicare savings programs.