Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Quick answer: Diabetic Shoes Medicare Coverage is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
The most important clinical decision with Diabetic Shoes Medicare Coverage isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Diabetic Shoes Medicare Coverage: Quick Answer
Medicare covers $500-$800 of diabetic shoes and inserts annually for qualifying patients – but most diabetics never use this benefit because they do not know it exists. We dispense Medicare-covered diabetic shoes weekly at Balance Foot and Ankle. Here is exactly how the program works.
Quick Eligibility Check
You qualify for Medicare-covered diabetic shoes if ALL of these are true: 1. You have diabetes (Type 1 or Type 2). 2. You have at least ONE qualifying foot complication (see next section). 3. Your PCP or endocrinologist documents these and prescribes diabetic shoes. 4. You receive shoes from a Medicare-certified DME supplier (we are one).
Qualifying Foot Complications
You need at least ONE of: 1. Peripheral neuropathy (loss of protective sensation – diagnosed by monofilament testing or nerve conduction). 2. History of foot ulceration (any time in the past, on either foot). 3. History of pre-ulcerative callus (heavy callus that broke down). 4. History of partial or complete amputation. 5. Foot deformity (bunion, hammertoe, Charcot, claw toes, hallux valgus). 6. Poor circulation (PAD, ABI <0.9, absent pulses).
What Medicare Covers (DME Codes)
Annual benefit (resets each calendar year): 1 pair of extra-depth diabetic shoes (HCPCS code A5500) – approximately $200-$400 value. 3 pairs of inserts – either custom (A5512) or heat-molded (A5513) – approximately $300-$500 value. Total annual benefit value: $500-$900. Patient cost: 20% coinsurance after Part B deductible (~$240 in 2026).
Types of Inserts Available
Custom-molded inserts (A5512): Made from impressions of your feet. Best for severe deformity, history of ulcer, neuropathy. Lifespan 1-2 years. Heat-molded inserts (A5513): Pre-made shells heated and shaped to your foot. Best for mild deformity, less expensive. Lifespan 1 year. We choose based on your foot anatomy and risk factors.
Approved Shoe Brands
Medicare-approved diabetic shoe brands include: Dr. Comfort (most variety), Drew Shoes, Apex, Orthofeet, Propet, P.W. Minor, SAS, New Balance (selected models). All have extra depth (5/16+ inch) for inserts and roomy toe boxes. Athletic, dress, casual, sandal, and boot styles available – you do not have to wear “old people shoes.”
Step-by-Step Process to Get Shoes
1. Schedule visit with your PCP or endocrinologist – request diabetic shoes evaluation. 2. PCP documents diabetes diagnosis + qualifying foot complication in chart. 3. PCP writes prescription for “diabetic depth shoes A5500 + inserts A5512 or A5513.” 4. Bring prescription to Medicare-certified DME supplier (we are one). 5. Get fitted, choose styles, place order. 6. Receive shoes/inserts in 1-3 weeks. 7. Annual replacement available each calendar year.
Common Coverage Mistakes
Wrong supplier: Big box stores and most online sellers are NOT Medicare DME providers – your benefit cannot be billed through them. Missing documentation: Without proper PCP documentation of qualifying complication, claim denied. Same calendar year shoes already received (one pair per year limit). Wrong codes – we ensure correct A5500/A5512/A5513 billing. We handle ALL paperwork for you.
Why Diabetic Shoes Matter
Properly fitted diabetic shoes prevent: foot ulcers (50-70% reduction), amputations (50% lifetime reduction), chronic wounds, charcot foot deformity progression. Diabetics with neuropathy who do NOT wear protective shoes have a 25% lifetime risk of amputation. Proper shoes are not vanity – they save limbs.
Annual Replacement Strategy
Use your benefit January-March every year so you have shoes for spring. Keep last year shoes as backup or for yard work. Replace inserts more often than shoes (1 pair every 4 months works well). Track when shoes were dispensed – benefit resets on January 1 each calendar year. Schedule a diabetic foot exam to start your annual benefit.
When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your diabetic foot, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Frequently Asked Questions About Diabetic Shoes Medicare Coverage
Does Medicare really pay for diabetic shoes?
Yes – Original Medicare Part B covers 1 pair of diabetic shoes plus 3 pairs of inserts per calendar year for qualifying diabetics. Patient pays 20% coinsurance after Part B deductible.
Who qualifies for Medicare diabetic shoes?
Diabetics with at least one of: peripheral neuropathy, history of ulcer, foot deformity, history of amputation, pre-ulcerative callus, or poor circulation. PCP must document qualification.
How much do diabetic shoes cost with Medicare?
20% coinsurance after Part B deductible. Total out-of-pocket usually $50-$200 per year. Without Medicare: $200-$500 per pair plus $200-$400 for inserts.
How often can I get new diabetic shoes?
Once per calendar year (resets January 1). One pair of shoes plus three pairs of inserts annually.
Where can I get Medicare-covered diabetic shoes?
Only from Medicare-certified DME suppliers. We are one – we directly bill Medicare for you. Big box stores and most online sellers cannot bill Medicare.
What styles of diabetic shoes are available?
Athletic, walking, dress, casual, sandal, boot styles from brands like Dr. Comfort, Drew, Apex, Orthofeet, New Balance, and SAS. Modern designs – not “old people shoes.”
Do I need a referral or just a prescription?
Original Medicare requires only a written prescription from PCP or endocrinologist documenting diabetes plus qualifying complication. No specialist referral needed unless your Medicare Advantage plan requires it.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.