Medicare Coverage Facts for Podiatry Care

This overview will cover Medicare's coverage of podiatry services, including what is generally covered, what is not, and specific considerations for individuals with diabetes. It will also touch on how Medicare Advantage and Medicare Supplement plans might affect your coverage and costs. The information is based on several sources, including eHealth, AARP, UnitedHealthcare, Medicare.gov, U.S. News & World Report, and Central Florida Foot & Ankle Institute. These sources provide a comprehensive view of Medicare's policies regarding podiatry and foot care, offering different perspectives from insurance providers, medical associations, and government resources.

Episode Transcript

(00:00):
Welcome to the Podiatry Insight Hub, the leading informational audio platform for common care

(00:07):
and treatments related to lower extremity.
Get ready for another great podiatry topic in today's post.
Ready, set, here we go.
Disclaimer, the content provided in this audio is for informational purposes only and should
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.

(00:28):
This is to seek the advice of a physician or another qualified health provider with
any questions or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship and no liability is assumed for any decisions made based solely
on the information presented.
Hey everybody and welcome to another deep dive.
You ready to get into something we all need to think about at some point?

(00:49):
Always ready for a good deep dive.
Awesome.
So today we're going to be tackling foot care and Medicare.
A very important topic.
Absolutely.
And it can get a little complicated.
So we're going to be using Medicare.gov as a source along with some AARP articles.
Excellent sources.
And we're also going to be talking to some pod-a-tree professionals just to get their

(01:09):
take on all of this.
Get the inside scoop.
Exactly.
Yeah.
Now the first thing that really surprised me when I started researching this is that Medicare
Part B doesn't usually cover routine foot care.
Yeah, that's something that trips a lot of people up.
It really does.
Yeah.
So everything is essential as foot care would be covered.
Right.
Especially as we age.

(01:30):
Exactly.
It becomes even more important to take care of our feet.
And more difficult for some people.
Absolutely.
So according to Medicare.gov, things like trimming your nails, removing corns and calluses, cleaning
and soaking your feet.
Those all fall under the category of routine foot care.
And they consider that personal comfort rather than medical necessity.

(01:52):
Which is interesting because as we age.
That's where you draw the line.
Exactly.
Because if you can't reach your feet to trim your nails properly.
And then you end up with an ingrown toenail.
Right.
That seems like a health risk to me.
It definitely can be.
So how do we navigate that then?
Because it seems like there's a gray area there.

(02:12):
There definitely is.
And it really comes down to whether a doctor says it's medically necessary.
Okay.
So if you can get your doctor to document that, you can't safely trim your nails yourself,
for example.
Then Medicare might cover it.
So it's really about advocating for yourself and having a doctor who's on your side.
Absolutely.
Okay.

(02:32):
So what about things like bunions or hammer toe?
Those are definitely considered medical conditions.
And Medicare will typically cover treatment for those.
So it sounds like Medicare steps in when there's an underlying condition or it goes beyond
basic maintenance.
That's a good way to put it.
All right.
Now what about diabetic foot care?
Because that seems like a whole other level of seriousness.
Oh, absolutely.

(02:53):
Diabetes can lead to some very serious foot problems.
Right.
Because of nerve damage and poor circulation.
So even small wounds can become big problems.
That's why Medicare has a whole section dedicated to diabetic foot care.
Okay.
So what kind of extra coverage do people with diabetes get?
Well, it's a little more nuanced than just more frequent visits.
Medicare Part B will cover foot exams every six months if you have nerve damage from diabetes.

(03:18):
But only if you haven't seen a foot specialist for another reason in that time.
So it's really important to coordinate your care.
Yes.
And you can't hang out of pocket if you see a podiatrist too often, even if it's for
different issues.
That's right.
So what else is covered under diabetic foot care?
One thing that a lot of people don't know about is therapeutic shoes.
Oh, really?
Medicare actually covers one pair of therapeutic shoes plus inserts each year.

(03:43):
Wow.
If you have severe diabetic foot disease.
I bet those are expensive.
They can be.
Where do you even go to get those?
You can get them from a variety of specialists.
Okay.
So you can't go to a pediatrist, orcetist, pedorthist, or prostatist.
So manyists.
I know, right?
But the key is they have to be enrolled in Medicare.
Okay.

(04:04):
So you can't just go to any shoe store.
Right.
It has to be the Medicare approved provider.
Exactly.
This is already starting to feel like a maze.
It definitely can be.
You've got routine care, medically necessary care, diabetic care.
It's a lot to keep track of.
And then on top of all that, you've got Medicare Advantage Plants.
Right.

(04:24):
So that's where private insurance comes in.
Does that change the foot care coverage game at all?
It can, significantly.
Oh, really?
Medicare Advantage Plants have to cover at least the same services as original Medicare
Part B.
Okay.
But they often have extra benefits, including more podiatry coverage.
So it's kind of like the premium version of Medicare when it comes to foot care.
In some cases, yes.
But like everything else with Medicare Advantage.

(04:46):
You have to do your research.
Yeah.
Because coverage and costs can vary widely between plans.
Exactly.
All right.
So we've covered the basics of what's covered and what's not when it comes to podiatry and
Medicare.
We've laid the groundwork.
But this is just the tip of the iceberg.
There's a lot more to explore.
We still need to dig into the costs involved.

(05:07):
Absolutely.
The differences between original Medicare and Medicare Advantage.
And even some of the bigger questions about foot care and Medicare.
Stay tuned, folks.
We'll be right back after a quick break to delve even deeper into this fascinating topic.
We're back and ready to keep digging into this foot care and Medicare situation.
It's definitely a topic worth exploring in depth.

(05:29):
It is.
So last time we talked about what's covered and what's not.
Right.
We laid out the basic landscape.
Exactly.
But now I want to talk about the costs.
Because even when something IS covered, there are still costs involved.
Exactly.
So with original Medicare Part B, you've got that 20% quinsurance after you meet the deductible.
Right.
So how much are we actually talking about here?

(05:50):
Well, first you've got the Part B deductible.
Right.
Which for 2023 is $226.
And then Medicare covers 80% of the approved costs for podiatry.
So if you have a $200 podiatrist visit.
You would pay $40 out of pocket.
And that can add up quickly if you need regular care.
It definitely can.
Which is why some people choose to get a Medigap plan.

(06:11):
Right.
Medigap can help cover some of those out-of-pocket costs.
Can you remind us how those work?
Sure.
So Medigap plans are sold by private insurance companies.
Okay.
They're designed to supplement original Medicare.
Okay.
They can help cover things like copayments, coinsurance, and deductibles.
So it's like extra insurance on top of your insurance.

(06:31):
That's a good way to think about it.
That makes sense for people who want more predictable costs.
Exactly.
But can you have a Medigap plan if you have Medicare Advantage?
No.
Medigap plans are specifically for people with original Medicare.
Got it.
So with Medicare Advantage, you're relying on that plan's coverage.
And costs.
Right.
So it's super important to compare plans.
Absolutely.

(06:51):
So you might have low copays, but a high deductible.
Right.
Or they might have specific benefits for certain conditions, like diabetes.
So if you have diabetes, you'll need a lot of foot care.
You might want to look for a Medicare Advantage plan that's tailored to diabetes.
Makes sense.
Those plans often have more comprehensive coverage.
For diabetic supplies, medications, and specialist visits.

(07:12):
Including podiatry.
Yes.
Okay.
So it's not just about the podiatry line on the plan.
You have to look at the whole picture.
The overall benefits package.
Exactly.
So talking about all of this, I'm wondering why routine foot care isn't just included
in Medicare.
That's a question a lot of people have.
It seems like preventing those minor issues could save a lot of trouble and money in the

(07:35):
long run.
There are definitely arguments on both sides.
Like what?
Well, on one hand, you have the preventative care argument.
Right.
Early intervention could prevent those small issues from becoming big, expensive problems.
Like that ingrown toenail example we talked about.
Exactly.
If Medicare covered basic nail care, maybe fewer people would end up needing surgery or

(07:57):
something.
It's possible.
And there's also the equity issue.
Right.
People who can't afford routine foot care might wait until it's a serious problem.
Which could have been avoided with some basic care.
Exactly.
But I imagine it would be really expensive to cover routine foot care for everyone on
Medicare.
That's the main argument against it.
Like honest.
Expanding coverage would definitely come with a big price tag.

(08:18):
And how do you even define routine care?
Right.
Where's the line between medical necessity and personal preference?
A pedicure could be routine maintenance for one person.
And a medical necessity for another.
So it's complicated.
It is.
But it seems like a conversation worth having.
Absolutely.
So what are your thoughts on all of this?
As an expert in this field.

(08:38):
Yes.
Personally, I believe that investing in preventative care, including foot care, can lead to better
health outcomes.
And potentially lower costs in the long run.
Exactly.
But it's a complex decision with a lot of factors to consider.
This is really highlighting how much health care policy impacts our lives.
It really does.
Even in something as seemingly simple as foot care.

(09:00):
It all comes back to policy in the end.
And it shows how important it is to stay informed and ask questions.
And advocate for the care we need.
Well said.
We're back for our final look at foot care and Medicare.
And I have to say I'm walking away with a lot more knowledge than I had before.
I think that's the goal of any deep dive.
To really get into the nitty gritty.

(09:20):
It is.
And I feel like we've done that with this topic.
I agree.
It's been a good deep dive.
It has.
And I think it's really important to understand how Medicare coverage works.
Because it can be confusing.
Especially when it comes to something as essential as foot care.
Right.
We rely on our feet every day.
Exactly.
So we need to know how to advocate for ourselves.

(09:41):
And how to make sure we're getting the care we need.
So one thing we've talked about is the gaps in coverage for routine foot care.
Right.
There's a lot of debate about whether that should be included.
And there are valid points on both sides.
But in the meantime, what can we do to push for better access to care?
Especially for people who can't afford it.
That's a great question.
Well, first of all, we need to spread awareness.

(10:02):
Okay.
Talk to your friends and family.
Yeah.
Your elected officials.
Make some noise.
Exactly.
Let people know that this is an important issue.
Are there any organizations that are working on this that we could support?
Absolutely.
The American Podiatric Medical Association is a great resource.
They advocate for policies that improve foot health access.

(10:25):
Makes sense.
And what about AARP?
AARP is another good one.
Especially for people 65 and older.
They have a lot of information on Medicare and health care issues.
So knowledge is power.
It really is.
All right.
So aside from advocating for change, what are some things we can do to take care of
our feet now?
Even if that routine care isn't covered by Medicare.

(10:45):
Right.
Because we still got to take care of ourselves.
Absolutely.
Well, the first thing is to regularly inspect your feet.
Look for any cuts, sores, changes, anything unusual.
Got it.
And wear comfortable shoes.
Ones that fit properly.
Exactly.
Support your feet.
And if you notice anything concerning, don't hesitate to see a doctor.
Early detection is key.

(11:06):
Especially for people with diabetes.
Speaking of which, we talked about the importance of those regular checkups with a podiatrist.
For people with diabetes.
Any other advice specifically for them?
Yes.
Diabetic foot care is so important.
Right.
Because even small problems can become big problems.
Exactly.
So keep your blood sugar levels under control.
Okay.

(11:26):
Follow your doctor's recommendations for foot care.
And don't try to treat things yourself.
That's right.
Leave it to the professionals.
All right.
So the big takeaway here is to be proactive and informed.
Take care of your feet.
And advocate for better care.
I think that's a great message to end on.
Me too.
Well, this has been a really eye-opening deep dive.

(11:48):
I feel like I've learned so much.
I'm glad to hear that.
And I hope our listeners have too.
It's been a pleasure sharing this information with you and with them.
So before we sign off, is there one final thought you want to leave our listeners with?
Maybe something to ponder as they continue their own deep dives into this topic.
Yeah.
A little homework.
Here's a question.
If Medicare were to expand coverage for routine foot care, how should they determine medical

(12:14):
necessity?
That's a good question.
Because where do you draw the line?
It's a complex issue.
But it's an important one.
And it's one that we need to be thinking about.
We can't just sit back and wait for someone else to solve it.
We need to be part of the solution.
Well said.
And on that note, I think we've reached the end of our deep dive into podiatry and Medicare.

(12:34):
It's been a journey.
A fascinating one.
A huge thank you to you for sharing your expertise.
My pleasure.
And to our listeners for joining us.
Thank you for listening.
Until next time, keep on deep diving.
Disclaimer, the content provided in this audio is for informational purposes only and should
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.

(12:55):
Always seek the advice of a physician or another qualified health provider with any questions
or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship, and no liability is assumed for any decisions made based solely
on the information presented.