Podiatrist Accepting Medicare in Michigan | Balance Foot & Ankle

Medically reviewed by Dr. Tom Biernacki, DPM, FACFAS

Board-certified foot & ankle surgeon · Balance Foot & Ankle

Last reviewed July 2026 · (810) 206-1402

Short answer: yes. Balance Foot & Ankle accepts Medicare at both our Howell and Bloomfield Township offices. Medicare Part B covers medically necessary foot and ankle care, and we’ll confirm your exact benefits and out-of-pocket cost before your visit. Call (810) 206-1402 or request an appointment — new Medicare patients are welcome and we offer same-week visits.

What does Medicare cover for foot care?

Medicare Part B covers podiatry that is medically necessary — that is, treatment of a diagnosed foot or ankle problem. For most patients that includes:

• Heel pain and plantar fasciitis, bunions, hammertoes, ingrown toenails, and ankle injuries
• Diabetic foot care and at-risk foot exams
• Wound care, in-office procedures, and injections
• Treatment of foot infections, fractures, and deformities
• Foot and ankle surgery when it’s medically necessary

What Medicare usually does NOT cover

By federal law, Medicare does not cover routine foot care — things like basic nail trimming or callus removal — when there’s no underlying medical condition. There is one big, important exception:

The diabetic / neuropathy exception. If you have diabetes with peripheral neuropathy (loss of protective sensation), or certain circulation disorders, Medicare does cover routine foot care, because trimming your own nails or calluses becomes genuinely dangerous. This is one of the most valuable — and most underused — Medicare foot benefits. If you have diabetes, you should be having your feet checked regularly, and it’s covered.

Medicare’s diabetic therapeutic shoe benefit

If you have diabetes and at least one qualifying foot condition (neuropathy, a past ulcer, foot deformity, poor circulation, prior amputation, or significant calluses), Medicare Part B covers one pair of therapeutic shoes and three pairs of custom inserts each calendar year. The doctor managing your diabetes certifies the need, and a podiatrist fits and orders them. We handle this program start to finish — learn more about the diabetic shoe program.

What will it cost?

With Original Medicare in 2026, you pay the annual Part B deductible ($283), then typically 20% of the Medicare-approved amount for covered podiatry; Medicare pays the other 80%. Many patients have a Medigap (supplement) plan that covers that 20%. If you have a Medicare Advantage plan (such as Medicare Plus Blue, Aetna, Humana, or Priority Health Medicare), your copays and rules differ — some plans require prior authorization or referrals. We verify all of this for you before your appointment so there are no surprises.

Do I Need a Referral to See a Podiatrist with Medicare?

With Original Medicare (Part A and Part B), you do not need a referral from your primary care physician to see a podiatrist. You can schedule directly with Balance Foot and Ankle. If you have a Medicare Advantage HMO plan, you may need a referral from your PCP depending on your specific plan rules. Our office can help you determine whether a referral is required when you call to schedule.

Medicare Coverage for Senior Foot Care Services

Many of our Medicare patients visit us for senior toenail care services, diabetic foot management, and medical pedicure services. For patients with qualifying systemic conditions such as diabetes, peripheral neuropathy, or peripheral arterial disease, Medicare covers routine foot care that would otherwise be excluded. Our team documents your medical conditions thoroughly to ensure maximum coverage.

How to Verify Your Medicare Coverage

Step 1: Call our office at (810) 206-1402 with your Medicare number (found on your red, white, and blue Medicare card).

Step 2: Let us know if you have a Medicare Supplement (Medigap) policy or a Medicare Advantage plan, and provide that information as well.

Step 3: Our team will verify your benefits and explain what your visit will cost before your appointment.

Have Blue Cross Blue Shield instead? BCBS is Michigan’s largest health insurer. Our Blue Cross Blue Shield podiatry coverage guide explains what BCBS pays for, when a referral is required, and how Blue Care Network rules differ from commercial BCBS plans.

Your board-certified podiatrists

Care is led by Dr. Tom Biernacki, DPM, FACFAS, a board-certified foot and ankle surgeon, with Dr. Carl Jay, DPM and Dr. Daria Gutkin, DPM. We see a large number of Medicare patients and emphasize keeping you mobile, comfortable, and out of the hospital — especially important for diabetic and older patients.

Two Michigan offices, same-week appointments

Howell (Livingston County): 4330 E Grand River Ave, Howell, MI 48843
Bloomfield Township (Oakland County): 43494 Woodward Ave #208, Bloomfield Township, MI 48302
Phone: (810) 206-1402

Looking for a Medicare podiatrist near you? Visit our Howell podiatry office or our Bloomfield Township podiatry office — both accept Medicare and welcome new patients.

Frequently asked questions

Does Balance Foot & Ankle accept Medicare?
Yes, at both offices, including Original Medicare and most Medicare Advantage plans. We verify your specific benefits before your visit.

Does Medicare cover toenail trimming?
Only when there’s a qualifying medical condition such as diabetes with neuropathy or poor circulation. For most healthy patients, routine nail care is not covered.

Does Medicare cover diabetic foot exams?
Yes — if you have diabetic peripheral neuropathy, Medicare covers a foot exam, generally once every six months, as long as you haven’t seen another foot-care specialist in between.

Can I get diabetic shoes through Medicare here?
Yes. If you qualify, Medicare covers one pair of therapeutic shoes plus three sets of inserts per year, and we manage the whole process.

Do I need a referral?
Original Medicare doesn’t require a referral for podiatry. Some Medicare Advantage (HMO) plans do — we’ll check yours.

Book your Medicare visit

Have Medicare and need a foot & ankle specialist in Livingston or Oakland County? Call (810) 206-1402 or request an appointment online. We’ll confirm your coverage and get you seen this week.

There are two ways onto the schedule. The faster one is to open the calendar for whichever office is closer and take a slot yourself:

→ See open times in Howell
→ See open times in Bloomfield Township

Choose New patient, then any weekday that suits you. Clinic days run Monday through Friday, so a calendar that looks empty today is usually just showing a weekend.

The other way is the form below. It is the better option if you want your Medicare details looked at first — tell us which office is closer, what your foot is doing, and whether you are on Original Medicare, a Medigap plan, or a Medicare Advantage plan. That last detail is what decides whether a referral is needed.

Phone

Name *

First

Last

Email *

Reason for Visit

Optional — a quick note helps us prepare, but you can skip it. We'll ask when we call.

Phone Reason for

Insurance Card (Optional)

Drag & Drop Files, Choose Files to Upload

Submit

This page is general information, not a coverage guarantee or medical advice. Medicare benefits depend on your plan and medical necessity; we confirm your specific coverage before treatment.

What Medicare Covers in Podiatry — and What It Doesn’t

The line between “medically necessary” and “routine” care is the single biggest source of billing surprises among new Medicare patients. Beyond the treatments above, covered care includes toenail debridement for diagnosed fungal nails (onychomycosis) when the nails are causing pain or skin breakdown, fracture care including casting and walking boots, and diagnostic imaging ordered by your podiatrist such as X-ray, MRI, or ultrasound. On the excluded side, routine hygienic care like soaking and cleaning, over-the-counter arch supports and inserts, cosmetic nail procedures, and flat-foot reconstruction without functional disability are not covered.

Orthotics and bracing follow very specific rules. Custom orthotic insoles for general comfort or biomechanical correction are not covered; the exception is an orthotic that is an integral part of a brace, such as an ankle-foot orthosis (AFO) prescribed for foot drop, severe instability, or post-stroke gait dysfunction. Walking boots and CAM walkers are covered for fractures, post-surgical immobilization, and acute injury, and compression stockings are covered for venous stasis ulcers with a documented diagnosis and prescription. Some Medicare Advantage plans add orthotic benefits with prior authorization.

For diabetic patients with documented peripheral neuropathy or peripheral arterial disease, routine foot care such as nail trimming and callus debridement is covered every 61 days, with the qualifying condition documented at each visit.

If your podiatrist expects Medicare to deny a service as not medically necessary, they must first give you an Advance Beneficiary Notice (ABN) — a form stating that Medicare may not pay and that you would be responsible for the full cost. You can sign and proceed, sign but ask that the claim still be submitted to Medicare (and appeal if denied), or decline the service. You should never be billed for a non-covered service without first receiving an ABN.

Medicare assignment, surgical coverage, and claim documentation

Medicare requires that podiatric care be performed by a provider who accepts Medicare assignment. Balance Foot & Ankle Specialists are participating Medicare providers — meaning we accept the Medicare-approved amount as payment in full and do not balance bill our patients.

Beyond office care, Medicare covers medically necessary foot and ankle surgery performed by podiatrists, and surgical coverage includes the surgeon’s fee, the facility fee, anesthesia, and postoperative care. Covered procedures include:

• Bunion correction (hallux valgus surgery) and hammertoe correction
• Neuroma excision and plantar fascia release
• Tendon repair and fracture fixation
• Joint fusion (arthrodesis) and ankle replacement

Prior authorization is required for most elective surgical procedures. The authorization process requires documentation of failed conservative treatment (typically three to six months), imaging studies confirming the diagnosis, and a letter of medical necessity from the treating podiatrist — our office handles the entire prior-authorization process. Covered surgery can be performed in a hospital outpatient department or an ambulatory surgical center (ASC); ASCs typically have lower facility fees, resulting in lower patient coinsurance, and your podiatrist can discuss the most appropriate surgical setting for your procedure.

Documentation matters for everyday claims, too. The most commonly denied podiatry claim is routine nail care without a qualifying diagnosis — adding the correct diagnosis code for peripheral neuropathy or peripheral vascular disease turns a denied service into a covered benefit for most Medicare patients. Even without a qualifying systemic condition, dystrophic nails (thickened, discolored, or deformed) can qualify when they cause pain, impair function, or create a risk of secondary infection. And if you use the therapeutic shoe benefit described above, it covers custom-molded or depth shoes and inserts that typically cost $400–800 out of pocket.

Turning 65: what changes for your foot care

Turning 65 and enrolling in Medicare is a major transition for your podiatric coverage. If you previously had employer insurance, you are moving from the commercial world to Medicare’s rules — and new Medicare enrollees in Michigan often discover that their podiatry coverage has changed significantly from their prior commercial plan. The good news: for seniors, most podiatric care qualifies as medically necessary, so evaluation and treatment of any diagnosable foot condition remains covered.

The change that catches many new enrollees off guard is routine foot care. The nail trimming that was covered as a routine visit under an employer plan is not covered as routine care under Medicare unless a documented systemic condition — such as diabetes, peripheral arterial disease, or peripheral neuropathy — makes self-care a medical risk, as described in the sections above. Our billing team is experienced in properly documenting those qualifying conditions so that claims are submitted correctly and your coverage is maximized.

How Medicare Advantage podiatry benefits differ

Medicare Advantage (Part C) plans are required to cover everything Original Medicare covers for podiatry, but many go further. Depending on the plan, extras can include routine foot care (nail trimming and callus removal) even for members without a qualifying systemic condition, additional podiatry visits per year, routine foot screenings, and lower fixed specialist copays in place of Original Medicare’s 20% coinsurance. The details depend entirely on which plan you are enrolled in.

Among major Michigan plans: BCBS Medicare Plus Blue PPO often includes enhanced routine foot care benefits, with specialist copays typically $30–45; Aetna Medicare Advantage plans often include routine foot care, with copays typically $20–40; United Healthcare AARP Medicare Advantage plans often cover routine foot care as well; Humana Gold Plus HMO plans cover medically necessary podiatry but require an in-network provider; and HAP Medicare Advantage is a Michigan-based plan with strong local network coverage.

Before a first podiatry visit on a Medicare Advantage plan, it is worth confirming with the member services number on your card:

• Whether your podiatrist is in your network, and whether a PCP referral is required
• Your specialist copay, and how many podiatry visits are covered per year
• Whether routine foot care is covered without a qualifying condition
• Whether prior authorization is required for orthotics or advanced treatments

Dr. Tom Biernacki, DPM

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.