The Ultimate Guide to Securing Orthotics Insurance Coverage

Are you currently considering purchasing a new pair of custom orthotics and are wondering whether you can take out insurance towards your purchase?

Custom orthotics can significantly reduce lower limb pain, injury risks, and conditions related to flat feet such as plantar fasciitis; especially in runners and other athletes. They're also individually tailored to your foot shape, providing superior support and cushioning.

Let's explore how you can secure insurance coverage for your custom orthotics, ensuring you can benefit from their enhanced comfort without financial strain.

Does Insurance Pay For Orthotics?

Whether you're purchasing over-the-counter orthotics or custom-designed ones, insurance can indeed provide financial assistance. Over-the-counter orthotics are typically covered if prescribed by a healthcare professional and are fairly affordable, usually ranging in price from $10-$20. The more intriguing question, though, is, 'are custom orthotics covered by insurance?'.

The answer is, partially. Custom orthotics usually aren't covered in full, but insurance can cover between 10-50% of the cost, helping to make them more accessible.

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Does Medicaid Cover Orthotics?

Medicaid generally covers medically necessary equipment, including custom orthotics. However, the specifics of an insurance plan can differ from state to state, so it's a good idea to consult directly with Medicaid to ensure the coverage you seek is available in your region

Does Medicare Cover Orthotics?

Under Medicare Part B insurance, you could have up to 80% of your custom orthotics' cost covered, provided:

• A Medicare doctor deems them medically necessary and prescribes them
• The orthotics are purchased from a Medicare-participating supplier
• You submit documentation confirming their medical necessity

How to Get Your Orthotics Covered by Insurance

In order to get your new orthotics covered by insurance, you will usually need to be able to provide the following documents:

• A list of your foot exam dates
• A document showing the medical diagnosis that the orthotics are required to treat, which can be provided by a physician, podiatrist, chiropodist or nurse practitioner
• A prescription for the custom orthotics from an eligible health care professional as mentioned above
• A description of the materials used to create the orthotics
• A description of the casting technique which was used to produce your custom fit
• A copy of a report from a physical foot examination and/or gait analysis
• Evidence of the cost and payment for the orthotics

Once you have all of the above, there are several more steps that you need to take in order to get insurance coverage for your orthotics.

• Research different insurance plans to ascertain their coverage and if custom orthotics are included.
• Choose a plan from an insurance provider that covers your desired orthotics.
• Confirm the details by having the insurance underwritten. This will establish your personal eligibility and hasten the process if all the required documentation is ready.
• Pay your first premium by selecting your beneficiaries and paying your first premium.

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Get Comfortable with Affordable Orthotics

That's all the information you need to secure insurance coverage for your custom orthotics. Remember to check if you meet all necessary criteria and prepare your documentation in advance to ensure a seamless process. Once your perfect insurance coverage plan is in place, you can fully enjoy the benefits of your new custom orthotics, doing what you love with minimal pain and problems. Embark on this path today—your feet will thank you!