What Medicare Covers for Orthotics and When You Pay Out of Pocket

Medicare covers some orthotics, but not all, and the rules depend on whether your device is considered durable medical equipment or a shoe insert

Medicare Part B covers orthotics that are prescribed by a doctor and classified as durable medical equipment (DME) — meaning they are built to last and used repeatedly. This includes leg braces, arm braces, back braces, and custom-molded foot orthotics when they treat a medical condition like diabetes or arthritis. You pay 20 percent of the approved amount after you meet your Part B deductible, and Medicare pays 80 percent.

Orthotics that are not covered include over-the-counter shoe inserts, arch supports you buy at a drugstore, and devices considered "comfort" items rather than medical treatment. Shoe modifications — like adding a heel lift or rocker sole to an existing shoe — are also not covered. If your doctor prescribes an orthotic but Medicare denies it, you can request a review, though the outcome depends on whether the device meets Medicare's medical necessity standard.

Key Takeaways

Medicare Part B covers custom orthotics prescribed by a doctor when they treat a medical condition, and you pay 20 percent after your deductible.
Over-the-counter shoe inserts and arch supports are not covered, even if a doctor recommends them.
Your orthotic must come from a Medicare-approved DME supplier, not a retail store or online retailer.
If Medicare denies your claim, you can file an appeal within 180 days and ask for a detailed explanation of why the device was rejected.

How Medicare decides what orthotics are covered

Medicare uses a medical necessity standard: the orthotic must treat a specific medical condition, be prescribed by a doctor, and be the appropriate treatment for that condition. A custom foot orthotic for diabetic neuropathy, for example, meets this standard because it prevents pressure ulcers and complications. A generic arch support for mild foot pain does not, because it is considered a comfort device rather than medical treatment.

The type of orthotic matters. Custom-molded devices are more likely to be covered than prefabricated ones, though prefabricated orthotics can be covered if your doctor documents that a custom device is not medically necessary. Shoe inserts sold at retail stores are almost never covered, even if they are high-quality or expensive, because Medicare does not recognize them as medical devices.

Your doctor's documentation is critical. The prescription must state the medical condition being treated, why the orthotic is necessary, and how long it is expected to be used. If your doctor's note is vague — for example, "patient needs arch support" without mentioning a specific diagnosis — Medicare is more likely to deny the claim.

The role of DME suppliers and where to order from

You cannot order an orthotic from any retailer and have Medicare pay for it. Your orthotic must come from a Medicare-approved DME supplier. These suppliers are enrolled with Medicare and follow specific billing rules. Your doctor can refer you to an approved supplier, or you can search for one using Medicare's DME supplier directory on Medicare.gov.

When you work with an approved supplier, they handle the paperwork and billing. They submit your prescription to Medicare for review before making the device, which means you find out whether it will be covered before you pay anything. If Medicare approves it, the supplier bills Medicare directly and you pay your 20 percent coinsurance. If Medicare denies it, the supplier must tell you in writing before charging you.

Ordering from a non-approved supplier — even a well-known shoe store or online retailer — means Medicare will not pay, and you will owe the full cost. Some suppliers claim they are Medicare-approved when they are not, so always verify by checking the Medicare directory or calling Medicare at 1-800-MEDICARE.

What you pay: deductibles, coinsurance, and limits

Your out-of-pocket cost depends on your Part B deductible and coinsurance. In 2024, the Part B deductible is $240 per year. Once you meet it, you pay 20 percent of the Medicare-approved amount for the orthotic. If the approved amount is $500, you pay $100 and Medicare pays $400.

Medicare does not set a dollar limit on orthotics, but it does limit how often you can receive a replacement. For most orthotics, Medicare covers one replacement every five years. If you need a new one sooner, you will pay the full cost unless your doctor documents that the replacement is medically necessary due to a change in your condition.

If your orthotic costs more than the Medicare-approved amount, you may owe the difference. Some suppliers charge more than Medicare allows, and you are responsible for the overage. Always ask the supplier what the Medicare-approved amount is before you agree to the device.

Orthotics not covered by Medicare

Medicare does not cover shoe inserts for flat feet, high arches, or general foot pain unless they are custom-molded and prescribed for a specific medical condition. Over-the-counter products like gel insoles, cushioned inserts, and arch support sleeves are never covered. Compression sleeves, even when prescribed, are usually not covered unless they are part of a lymphedema treatment plan.

Shoe modifications are not covered. If you need a rocker sole, heel lift, or other change to an existing shoe, you pay for it yourself. Some orthotists can add these modifications to an orthotic device, which may be covered, but the shoe modification itself is not.

Orthotics for cosmetic reasons or comfort are not covered. If you want an orthotic to improve your athletic performance or make standing more comfortable without a medical diagnosis, Medicare will not pay for it.

How to request a review if Medicare denies your claim

If Medicare denies your orthotic claim, you have the right to appeal. The DME supplier should give you a written notice explaining why the claim was denied. Read it carefully — the reason might be that your doctor's documentation was incomplete, the device was not considered medically necessary, or the supplier was not approved.

You have 180 days from the date of the denial to file an appeal. You can do this yourself or ask the DME supplier to file on your behalf. Include any additional documentation from your doctor that supports the medical necessity of the device. For example, if Medicare said the orthotic was not necessary, your doctor can write a letter explaining why it is the appropriate treatment for your condition.

If you disagree with the appeal decision, you can request a hearing before an administrative law judge. This process takes longer but gives you a chance to present your case in more detail. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov for instructions on filing an appeal.

Frequently Asked Questions

Will Medicare cover custom orthotics for arthritis?

Yes, if your doctor prescribes them to treat arthritis-related pain or instability and they come from a Medicare-approved DME supplier. Your doctor's note must mention the arthritis diagnosis and explain why the orthotic is medically necessary. You pay 20 percent of the approved amount after your Part B deductible.

Can I use my Medigap or Medicare Advantage plan to cover the part Medicare doesn't pay?

Some Medigap plans cover the 20 percent coinsurance, depending on which plan you have. Medicare Advantage plans vary — some cover orthotics the same way Original Medicare does, while others have different rules. Check your plan documents or call your plan to ask what orthotics are covered.

What if my doctor prescribes an orthotic but says I should buy it at a shoe store instead of through a DME supplier?

Medicare will not pay if you buy it at a retail store, even with a prescription. You must order from a Medicare-approved DME supplier for Medicare to cover it. Ask your doctor to refer you to an approved supplier, or find one using Medicare's directory.

How long does it take Medicare to decide if my orthotic is covered?

The DME supplier usually submits your prescription for review before making the device. This can take one to two weeks. Once Medicare makes a decision, the supplier will contact you. If approved, they bill Medicare and you pay your coinsurance when you pick up the device.

Can I get a replacement orthotic if mine wears out before five years?

Medicare covers one replacement every five years for most orthotics. If yours wears out sooner, you pay the full cost unless your doctor documents that a replacement is medically necessary due to a change in your condition — for example, if you gained significant weight or your condition worsened.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.