What's the difference between covered and non-covered orthotics under Medicare?

Covered under Medicare: ankle-foot orthoses (AFOs) for neurological conditions causing drop foot; custom-molded diabetic inserts (within the diabetic shoe benefit); knee braces for OA (sometimes covered); post-surgical ankle braces. Not covered: custom foot orthotics for plantar fasciitis, flat feet, or biomechanical conditions; prefabricated arch supports; shoe insoles. The key distinction is whether the device replaces or substitutes for a missing or non-functioning body part (prosthetic) or prevents/corrects a deformity that impairs body function (orthotic in Medicare's definition).

Can I use my FSA or HSA for custom orthotics?

Yes — custom orthotics prescribed by a licensed healthcare provider are a qualified FSA/HSA medical expense in most cases. You'll need: (1) A prescription/Letter of Medical Necessity from your podiatrist; (2) An itemized receipt from Balance Foot & Ankle. Using pre-tax FSA/HSA dollars effectively saves you 20-30% on orthotic costs. Check with your FSA/HSA plan administrator to confirm, as policies vary slightly. Inform Balance Foot & Ankle staff that you're using FSA/HSA funds — we'll provide all necessary documentation.

How much do custom orthotics cost without insurance?

Custom orthotics at Balance Foot & Ankle range from $300-$600 depending on type and complexity. Our 3D-printed custom orthotics use advanced scanning technology for a precise fit at competitive pricing. When amortized over 3-5 years of use, the daily cost is often less than $0.50. Compare this to: repeated OTC insole purchases ($30-$80 each, replaced every 3-6 months), ongoing medication for foot pain, and physical therapy copays. Most patients find custom orthotics to be a cost-effective long-term investment in foot health.

Does Medicare cover custom orthotics for foot pain?

Medicare Part B covers custom orthotics (therapeutic shoes or inserts) for diabetic patients who qualify under the Therapeutic Shoe Bill. For non-diabetic patients, custom orthotics are generally not covered by Original Medicare unless part of a covered surgical or injury treatment. Call Balance Foot & Ankle at (810) 206-1402.

What are the Medicare requirements for diabetic shoe coverage?

To qualify for Medicare diabetic shoe coverage, you must have diabetes, be enrolled in Medicare Part B, have a podiatrist or other qualified provider certify your need, and have the shoes/inserts prescribed and fitted by a podiatrist or pedorthist. Balance Foot & Ankle handles all Medicare diabetic shoe documentation. Call (810) 206-1402.

How many pairs of orthotics does Medicare cover per year for diabetics?

Medicare covers one pair of therapeutic shoes plus three pairs of custom-molded inserts or two pairs of custom-molded shoes per calendar year for qualifying diabetic patients. Balance Foot & Ankle manages the entire Medicare fitting and billing process for diabetic therapeutic footwear.

Can Medicare Advantage plans offer better orthotic coverage than Original Medicare?

Yes, some Medicare Advantage plans offer expanded orthotic benefits beyond Original Medicare's diabetic shoe program. Coverage varies by plan. Balance Foot & Ankle recommends calling (810) 206-1402 so we can review your specific Medicare Advantage plan's orthotic benefits before your appointment.

Does Medicare cover over-the-counter orthotics?

No, Medicare does not cover over-the-counter insoles or store-bought orthotics. Only custom-molded therapeutic footwear prescribed by a podiatrist for qualifying diabetic patients is covered. Balance Foot & Ankle in Howell (4330 E Grand River) and Bloomfield Hills (43494 Woodward Ave #208) provides Medicare-compliant custom orthotics and diabetic shoes.

When should I see a podiatrist?

For persistent foot/ankle pain, difficulty walking, numbness, non-healing wounds, skin changes, or deformities. Dr. Biernacki offers same-day appointments. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major plans including BCBS, Aetna, United, Cigna & Medicare. Call 810-206-1402 to verify coverage. Affordable self-pay options available.

What to expect at your first podiatry visit?

Comprehensive evaluation including history, exam, biomechanical assessment, and in-office X-rays. Same-day diagnosis and treatment when possible. Most visits take 30-45 minutes.

Does Medicare cover custom orthotics for foot pain?

Medicare covers custom orthotics (foot orthoses) when prescribed by a qualified provider for specific medical conditions. Diabetic patients with qualifying foot conditions are covered under the Therapeutic Shoe Bill. Non-diabetic coverage requires documentation of medical necessity.

What are the requirements for Medicare orthotic coverage?

To qualify for Medicare-covered custom orthotics, you need a prescription from your treating physician, documentation of a qualifying diagnosis (such as diabetic neuropathy, severe arthritis, or post-surgical recovery), and the orthotics must be provided by a Medicare-enrolled supplier.

How often will Medicare pay for new custom orthotics?

Medicare generally covers replacement custom orthotics every 2 years if medical necessity is documented. Diabetic therapeutic inserts can be replaced every calendar year (3 pairs per year). More frequent replacement may be approved with documentation of significant changes in foot structure.

✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

Does Medicare Cover Custom Orthotics? What Michigan Patients Need to Know

Medicare can cover custom foot orthotics — but there are specific requirements for medical necessity, documentation, and the type of orthotic. This guide explains exactly when Medicare covers orthotics, what documentation you need, and how our 3D-scanned custom orthotics qualify.

When Medicare Covers Custom Orthotics

Medicare Part B covers custom-fabricated orthotics (also called Ankle-Foot Orthoses/AFOs or custom insoles) when ALL of the following are true:

The orthotic is medically necessary for a documented condition
A physician prescribes the orthotic as part of a treatment plan
The orthotic must be custom-fabricated (not prefabricated/off-the-shelf) to qualify for the higher Level II benefit
The orthotic is obtained from a qualified provider

Conditions That Typically Qualify for Medicare Orthotic Coverage

Drop foot or foot drop (weakness causing inability to lift front of foot)
Severe flatfoot with associated pain and functional limitation
Diabetic foot deformities requiring pressure offloading
Ankle instability from ligament damage
Post-surgical foot reconstruction requiring support
Severe arthritis causing significant foot deformity and gait abnormality
Charcot foot (diabetic neuroarthropathy)
Limb length discrepancy greater than 1.5 cm

What Medicare Does NOT Cover for Orthotics

Prefabricated (over-the-counter) insoles — these are not covered even if a doctor recommends them
Orthotics for conditions that haven’t been adequately documented as causing functional limitation
Orthotics for comfort only without documented medical necessity

Our 3D-Scanned Custom Orthotics and Medicare

At Balance Foot & Ankle, we produce custom orthotics using 3D scanning technology — far more precise than traditional plaster casting. When prescribed for a qualifying medical condition with proper documentation, these custom orthotics qualify for Medicare coverage. We handle the documentation and billing.

Medicare Advantage and Commercial Insurance

Coverage varies more broadly among Medicare Advantage and commercial plans. Some plans cover custom orthotics with less stringent requirements; others require pre-authorization. We verify your specific plan benefits before prescribing orthotics, so you always know what you’ll pay before treatment begins.

✅ Free Insurance Verification
Not sure what your plan covers? Our team verifies your insurance before every visit — no surprise bills, no confusion.
📞 (810) 206-1402 | Howell: 4330 E Grand River Ave | Bloomfield Hills: 43494 Woodward Ave #208
We accept Medicare, Medicare Advantage, BCBS, Aetna, United Healthcare, Cigna, Humana, HAP, Molina, Meridian, Priority Health, Oscar, McLaren, Workers’ Comp, VA, and most Michigan insurance plans.

⚡ Advanced Technology at Balance Foot & Ankle
✅ MLS Dual-Wavelength Laser — FDA-cleared
✅ EPAT Shockwave Therapy — 80%+ success rate
✅ Magnetotransduction (EMTT) — Deep electromagnetic healing
✅ 3D-Scanned Custom Orthotics
✅ Toenail Fungus Laser
✅ In-Office X-Ray & Ultrasound
✅ Diabetic Shoe Program — Medicare-covered
📞 (810) 206-1402 | Howell & Bloomfield Hills

📞 Call (810) 206-1402 to learn whether your foot condition qualifies for Medicare-covered custom orthotics.

Professional Podiatric Care in Michigan: Balance Foot & Ankle’s Comprehensive Services

At Balance Foot & Ankle, Michigan patients receive comprehensive podiatric care across the full spectrum of foot and ankle conditions. Our fellowship-trained podiatrists provide conservative and surgical treatment for all foot and ankle pathology — from plantar fasciitis, bunions, and nail disorders to complex reconstructive surgery, diabetic foot care, and sports injuries. Our clinical approach prioritizes accurate diagnosis, evidence-based treatment selection, and honest communication with patients about realistic outcomes.

We serve patients in Livingston and Oakland counties from two convenient Michigan locations: our Howell office at 4330 E Grand River (serving Brighton, Hartland, Pinckney, Howell, and all of Livingston County) and our Bloomfield Hills office at 43494 Woodward Ave #208 (serving Troy, Birmingham, West Bloomfield, Farmington Hills, and all of Oakland County). Both offices offer in-office X-ray, same-week new patient appointments, and a full range of diagnostic and treatment services. We accept Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna, Medicare, and most Michigan insurance plans. Call Balance Foot & Ankle at (810) 206-1402 to schedule your appointment.

Michigan patients from throughout the region — Livingston County communities including Howell, Brighton, Hartland, Pinckney, and Fowlerville, and Oakland County communities including Bloomfield Hills, Troy, Birmingham, West Bloomfield, Farmington Hills, Pontiac, and Rochester — can access expert podiatric care at Balance Foot & Ankle. Our clinical team is committed to providing the highest standard of foot and ankle care available in Southeast Michigan, from routine preventive care to complex surgical intervention. Call (810) 206-1402 to schedule — we look forward to serving you at our Howell or Bloomfield Hills location.

Michigan patients can access expert custom orthotics in Michigan at Balance Foot & Ankle. Our board-certified podiatrists serve Howell (4330 E Grand River) and Bloomfield Hills (43494 Woodward Ave #208). Schedule an appointment online or call (810) 206-1402 for same-week availability.

Medical References & Sources

Dr. Tom’s Recommended Products for Flat Feet & Arch Support

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Need Custom Orthotics? Check Your Medicare Coverage

Medicare covers custom orthotics for qualifying conditions like diabetes and arthritis. Let us verify your eligibility and get you fitted with the right support.

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Clinical References

Centers for Medicare & Medicaid Services. Therapeutic shoes for persons with diabetes. Medicare Coverage Database. 2025.
Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. 2008;(3):CD006801.
Bus SA, van Netten JJ, Hissink RJ, et al. Effects of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial. Diabetes Care. 2013;36(12):4109-4116.

Dr. Tom Biernacki, DPM

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.