Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Medicare Part B covers one pair of depth-inlay diabetic shoes plus three pairs of custom-molded inserts per calendar year for qualifying diabetic patients under the Therapeutic Shoes for Persons with Diabetes benefit (HCPCS A5500/A5501/A5503-A5508). To qualify, a patient must have diabetes mellitus, be enrolled in Part B, and have a certifying physician (typically the treating physician for diabetes) document that the patient is at risk for lower extremity complications. A podiatrist then performs the fitting and provides the footwear.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
Why Diabetic Patients Need Specialized Footwear
Diabetes damages foot health through two converging mechanisms: peripheral neuropathy (loss of protective sensation) and peripheral arterial disease (reduced blood flow). Together, these create a foot that cannot detect injury and cannot heal efficiently. A minor pressure point that a healthy foot would sense and relieve goes unnoticed in a neuropathic foot — and what begins as redness or a callus progresses to a full-thickness ulcer within days to weeks.
Standard retail footwear — even well-fitting athletic shoes — creates focal pressure points at the toes, metatarsal heads, and heel that are manageable for sensate feet but dangerous for diabetic feet. The American Diabetes Association estimates that 15% of diabetic patients will develop a foot ulcer in their lifetime, and 85% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Therapeutic footwear is among the most effective interventions to break this chain.
The Medicare Therapeutic Footwear Benefit
Medicare Part B covers therapeutic footwear for qualifying diabetic patients under the Therapeutic Shoes for Persons with Diabetes benefit. Coverage includes one pair of depth-inlay shoes (HCPCS A5500) or custom-molded shoes (A5501) per calendar year, plus three pairs of inserts (A5512/A5513).
To qualify, patients must: (1) have diabetes mellitus diagnosed by a physician, (2) be enrolled in Medicare Part B, and (3) have documentation of at least one of the following high-risk conditions: peripheral neuropathy with callus formation, history of pre-ulcerative calluses, history of previous ulceration, foot deformity, previous amputation, or poor circulation.
The certifying physician (typically the patient’s endocrinologist, primary care physician, or internist managing the diabetes) must sign the certification statement. Our office handles the fitting, dispensing, and billing. Most patients owe nothing beyond their standard Medicare Part B deductible and 20% coinsurance — with supplemental insurance often covering that remainder entirely.
Depth-Inlay vs. Custom-Molded Shoes
Depth-inlay shoes are stock diabetic shoes with extra depth in the toe box (typically 3/16 to 5/16 inch more than standard shoes). This extra space accommodates hammertoes, bunion deformities, and custom inserts without creating toe-box pressure. Brands we frequently fit include Dr. Comfort, Orthofeet, and Propet — all available in standard, wide, and extra-wide widths.
Custom-molded shoes are fabricated from a plaster or foam cast of the patient’s foot. Indicated for severe foot deformities — Charcot foot collapse, severe hallux valgus with rigid deformity, or patients who cannot be fit in any depth shoe — custom-molded shoes eliminate virtually all pressure hot spots. Fabrication takes 2-4 weeks.
The accompanying custom-moldable inserts are heat-molded to the plantar contour of the patient’s foot. They distribute pressure evenly across the entire plantar surface rather than concentrating it at metatarsal heads and the heel rim. Research consistently shows custom inserts reduce peak plantar pressure by 30-40% compared to stock insoles.
Who Should Get Diabetic Shoes?
Any Medicare-enrolled diabetic patient with neuropathy, prior ulceration, foot deformity, callus formation, or peripheral arterial disease should take advantage of this benefit every calendar year. For higher-risk patients — those with active neuropathy, recurrent callus, or Charcot history — we also prescribe additional pairs of custom inserts at in-office cost to maintain protection year-round as inserts wear down.
Non-Medicare patients and commercially-insured diabetic patients should ask their carrier about therapeutic footwear benefits — many private plans mirror the Medicare benefit, particularly BCBS, Aetna, and United Healthcare plans with diabetes management riders.
Dr. Tom's Product Recommendations
Dr. Comfort William Men’s Diabetic Shoe
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Medicare-accepted depth-inlay diabetic shoe with 5E wide toe box, seamless interior lining, and gel insert. Removable insole accommodates custom orthotics. PDAC-approved code A5500. Available in multiple widths.
Dr. Tom says: “My podiatrist fitted me in these after I developed a pre-ulcerative callus under my 2nd metatarsal. Medicare covered them completely and the extra width eliminated all pressure on my toes.”
Medicare-enrolled diabetic men with neuropathy, hammertoes, bunions, or recurrent callus who qualify for the therapeutic footwear benefit
Patients needing custom-molded shoes for severe Charcot deformity — those require a cast and lab fabrication
Disclosure: We earn a commission at no extra cost to you.
Orthofeet Proven Plantar Fasciitis Relief Shoes (Women)
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Depth-inlay diabetic shoe with orthotic insole, anatomical arch support, and wide toe box. Non-binding upper accommodates bunions and hammertoes. Ergonomic sole reduces heel impact. PDAC-reviewed A5500 eligible.
Dr. Tom says: “I have neuropathy and bunions and these are the only shoes I can wear all day without pain. My podiatrist prescribed them through Medicare and I received three pairs of custom inserts with them.”
Diabetic women with neuropathy, bunions, hammertoes, or wide feet who qualify for Medicare therapeutic footwear
Narrow foot sizes — Orthofeet runs wide; patients with narrow feet should try Dr. Comfort or Propet instead
Disclosure: We earn a commission at no extra cost to you.
Powerstep Diabetic Insole (Extra Depth)
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Pressure-relieving diabetic insole with metatarsal pad, deep heel cup, and extra cushioning layer. Designed for depth-inlay shoes. Non-Medicare retail option for between-prescription-cycle insole replacement.
Dr. Tom says: “When my Medicare inserts wear down mid-year, my podiatrist suggested these as an affordable replacement to maintain protection until my next annual benefit.”
Diabetic patients who need insole replacement between annual Medicare benefit cycles, or non-Medicare patients seeking improved cushioning
Not a substitute for custom-moldable inserts for high-risk patients — those require clinical fitting
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Medicare covers diabetic shoes + 3 inserts annually — zero out-of-pocket for many patients
- 30-40% peak plantar pressure reduction from custom inserts vs. stock insoles
- Depth-inlay design eliminates toe-box pressure from hammertoes and bunions
- Therapeutic footwear is one of the most evidence-based ulcer prevention interventions
❌ Cons / Risks
- Requires physician certification — patient’s diabetes doctor must sign form before fitting
- Custom-molded shoes require 2-4 week fabrication lead time
- Only one pair of shoes per calendar year under Medicare — plan timing accordingly
- Commercial insurance coverage varies — prior authorization often required
Dr. Tom Biernacki’s Recommendation
The Medicare diabetic shoe benefit is one of the most underused preventive services in medicine. I see patients who have had diabetes for 20 years and never knew they were entitled to a free pair of therapeutic shoes every year. One pair of properly fitted diabetic shoes and custom inserts can prevent a foot ulcer — and a foot ulcer prevented is potentially an amputation prevented. If you have diabetes and Medicare, this benefit exists specifically for you.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How do I qualify for Medicare diabetic shoes?
You must have a diabetes diagnosis, be enrolled in Medicare Part B, and have documentation of a high-risk foot condition (neuropathy, callus formation, prior ulceration, foot deformity, poor circulation, or prior amputation). Your treating physician must certify you, and then our office handles the fitting and billing.
Does my primary care doctor need to be involved?
Yes — the certifying physician is typically the doctor managing your diabetes (PCP, endocrinologist, or internist). They complete a one-page certification form stating you meet the eligibility criteria. We can provide the form and coordinate with their office.
How much do diabetic shoes cost with Medicare?
Medicare covers 80% after your Part B deductible. Most supplemental (Medigap) plans cover the remaining 20%, making the shoes fully covered for most patients. We verify your specific coverage before ordering.
How often can I get new diabetic shoes?
Once per calendar year — one pair of shoes plus three pairs of inserts. We recommend scheduling in January to maximize your full year of protection.
What if I have a very deformed foot from Charcot?
Severely deformed feet that cannot be fit in any stock depth shoe require custom-molded shoes. We take a cast of your foot and send it to a lab. Medicare covers custom-molded shoes under A5501 with proper documentation of medical necessity.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can a podiatrist help with neuropathy?
What does neuropathy in feet feel like?
Is foot neuropathy reversible?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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