How Does Medicare Cover Diabetic Shoes? What NJ Residents in Hazlet Should Know

Key Takeaways

Medicare Part B covers one pair of diabetic shoes and up to three pairs of inserts each calendar year for individuals who have diabetes and a qualifying foot condition.

Two doctors are involved: the one managing your diabetes, who certifies that the shoes are medically necessary, and a podiatrist or other qualified physician, who writes the prescription.

After you’ve met the 2026 Part B deductible of $283, you pay 20 percent of the Medicare-approved amount. A Medigap plan can cover that portion.

You could end up paying far more than you should unless the shoes come from a supplier who is enrolled with Medicare and accepts assignment.

Why Diabetes Changes the Rules for Footwear

With diabetes, high blood sugar levels can gradually damage the nerves and blood vessels in your feet. As a result, you may not feel a blister developing, and healing takes longer than normal. A simple thing like a shoe that is too tight or a rough seam, which most people would notice right away, can turn into a sore before you’re aware of it. If the sore isn’t treated, it can develop into something much more serious. That’s why your feet need extra care and protection.

That’s exactly what diabetic shoes are for. They’re designed to prevent problems before they occur, with extra depth for the inserts, a wide toe box, smooth linings, and soles that distribute pressure across the entire foot. The inserts are built from layers of different densities so your feet get softness and support where each is needed most.

Therapeutic shoes from well-known brands such as Drew, Orthofeet, and New Balance now look very much like ordinary walking shoes. The old, bulky styles are largely gone, so you can feel comfortable and confident in shoes that look as good as they feel.

What Medicare Covers Each Year

The Therapeutic Shoe Benefit has been part of Medicare since 1993, and the details are simple once you know the figures. Each calendar year, a qualifying beneficiary can get one of the following:

One pair of extra-depth shoes plus three pairs of inserts, or

One pair of custom-molded shoes (with their inserts) plus two additional pairs of inserts

Custom-molded shoes are reserved for individuals whose foot deformity can’t be accommodated by an off-the-shelf extra-depth shoe. Medicare can also cover a shoe modification, such as a rocker sole or a wedge, in place of one of the insert pairs.

A professional fitting is part of the benefit. Because getting the right size and shape matters so much for diabetic feet, your supplier will take the time to measure you and fit the shoes properly, rather than simply handing you a box.

Who Qualifies

Having diabetes by itself is not enough. To qualify, the doctor treating your diabetes must verify that you have at least one of the following conditions in one or both feet:

A previous partial or complete foot amputation

A history of foot ulcers

Pre-ulcerative calluses

Nerve damage from diabetes with signs of callus formation

Poor circulation

A foot deformity such as a bunion or hammertoe

The doctor must also state that you’re being treated under a comprehensive diabetes care plan and that the shoes are needed because of your diabetes. Medicare wants to see that the footwear is part of managing a genuine medical risk, not simply a way to improve comfort.

The Two-Doctor Requirement

This is the stage that surprises people. Medicare calls for two separate approvals, and in most cases they come from two different doctors.

The first is the certifying physician, either an MD or a DO (in some states a nurse practitioner may also certify), who manages your diabetes. This is generally your primary care doctor or your endocrinologist. They sign a certification statement confirming you meet the criteria above, and Medicare also requires an office visit note showing your diabetes was addressed within the six months before you receive the shoes.

The second is the prescribing practitioner, usually a podiatrist, who examines your feet and writes the formal order for the shoes and inserts. The supplier can prepare the written order, but the podiatrist must review it and sign it.

For your claim to be paid, both doctors must be enrolled in Medicare. Medicare’s own compliance data shows that the most frequent cause of denied or delayed diabetic shoe claims is incomplete paperwork, not whether the person is eligible. Sorting out the documentation in advance keeps the process smooth for everyone. What You’ll Pay

After the annual Part B deductible has been met ($283 in 2026), Medicare pays 80 percent of the approved amount for the shoes and inserts. You pay the remaining 20 percent.

A Medigap policy will typically cover that 20 percent, which can bring your out-of-pocket cost down to nothing. Medicare Advantage plans are also required to cover therapeutic shoes, but copays and the list of approved suppliers differ from plan to plan, so check with your plan before booking a fitting.

Why the Supplier Matters

Medicare will only pay if the shoes come from an enrolled supplier who accepts assignment. When a supplier accepts assignment, they agree to take the Medicare-approved amount as full payment and bill you only for the deductible and coinsurance. If the supplier does not accept assignment, they can charge whatever they want, leaving you to pay the full amount upfront and hope for partial reimbursement later.

Hazlet Medical Supplies accepts Medicare, Medicaid, and most health insurance plans. The staff can help you work out which documents you already have and which ones you still need. The showroom at 3253 Route 35 in Hazlet is open six days a week and carries a good variety of diabetic shoes for both men and women. If the exact pair you’re looking for isn’t in stock, they’ll order it for you.

One Pair a Year, Every Year

The benefit resets every January, so you can get a new pair of shoes each year, provided you still qualify and your doctors complete the certification and prescription again. Many people don’t realize they can do this, but it’s a wise way to keep your feet protected. Over time, both shoes and inserts wear out, and a foot that’s already at risk deserves fresh protection.

If you have diabetes and any of the conditions mentioned above, discuss therapeutic shoes with your doctor at your next visit. It’s a simple, important step toward protecting your feet, and it’s a benefit that’s already available to you. Visit Hazlet Medical Supply today for more information about diabetic shoes.