Does Medicare Cover Toenail Care Toenail care Foot care Diabetic neuropathy

Routine foot care is rarely deemed medically necessary, but there are cases where Medicare will cover toenail care.

Original Medicare doesn’t typically cover routine foot care services, including toenail care, unless it’s considered medically necessary and ordered by your provider or a podiatrist. However, there are a few circumstances when Medicare beneficiaries may be covered for toenail trimming and other types of foot care.

For some Medicare beneficiaries, proper foot and toenail care can be difficult due to limited eyesight, limited flexibility, or arthritis in the hands, legs, and feet. However, it’s an important part of good overall health and helps prevent painful or even dangerous conditions. Read on to learn more about covered Medicare benefits and other options you may have.

Why is proper foot care important?

Proper foot and toenail care is actually an important part of your overall health and wellness. Toenails that aren’t properly taken care of can cause injury by scratching or puncturing your skin, breaking off and exposing skin under the nail, or tearing off from snagging on clothing or other materials.

Regularly trimming your nails (or getting them trimmed) can also allow you to check for signs of fungus, injuries, ingrown nails, and hangnails, all of which should properly be treated before they become serious.

Toenail and foot care is especially important for people with diabetes. Diabetes can cause neuropathy, which is nerve damage in the feet or legs, or peripheral artery disease, which can reduce the blood flow to the feet. These can increase the risk of ulcers and infections. If not properly cared for, diabetic neuropathy can also lead to foot amputations.

Medicare coverage for toenail and foot care

Medicare Part B (medical insurance) will cover any medically necessary treatment for foot injuries, disease, or other medical conditions that affect the feet and lower legs as long as a doctor or podiatrist documents the diagnosis and confirms the treatment is medically necessary.

For example, Medicare may cover treatment for foot problems from conditions such as cancer, chronic kidney disease, diabetes, multiple sclerosis, or vein inflammation related to blood clots. It may also cover care or treatment for foot ailments or injuries such as bunions, hammertoe, fungal infections in the nail, plantar warts, and heel spurs.

Toenail clipping may be covered if doing it yourself could be harmful to your health, or you have a health condition that deems this service necessary (like peripheral neuropathy, chronic phlebitis, or peripheral arterial disease). Part B will cover toenail cutting with a podiatrist every 61 days as long as you meet the requirements for cutting.

If you have ingrown toenails that are severe enough for removal, Medicare Part B will cover this outpatient procedure.

If you end up in a hospital due to a foot-related injury or condition, your inpatient hospital stay will be covered by Medicare Part A (hospital insurance). This includes inpatient services you receive when medically necessary, and if your podiatrist determines you need surgery to correct foot issues, it would also be covered by Part A.

If you have a Medicare Advantage plan (Part C), it must cover the same foot-related expenses as Original Medicare (though it may have different deductibles and co-pays). You may also have additional coverage depending on your plan, so check your Evidence of Coverage for more information.

There are also Special Needs plans (SNP), which are specific Medicare Advantage plans for patients with certain chronic conditions like diabetes. These plans may offer additional coverage for foot care if you qualify.

What types of foot care are not covered?

Original Medicare typically does not cover routine foot care. This includes cutting or removing corns and calluses, trimming, cutting, or clipping nails, and hygienic or other preventive maintenance (like cleaning and soaking your feet).

Unless considered medically necessary, in most cases, you would pay 100% of the cost for routine foot care out-of-pocket.

Other podiatry services covered by Medicare

If your condition is medically necessary, Medicare Part B covers things like prosthetic devices (like ankle braces), custom therapeutic shoes or shoe inserts (orthotics), toenail fungus treatments, surgical procedures for hammertoe (if done at an outpatient facility), and bunion treatments like toe spacers.

Some of these items may be considered durable medical equipment (DME) so you must get them from a certified DME supplier in order for them to be covered. Use the free search tool on Medicare.gov to learn if a service or treatment is covered and find a list of approved DME suppliers (find the link under additional resources).

Does Medicare cover foot care for diabetes?

Medicare provides extra foot-related coverage for beneficiaries with diabetes, including diabetic neuropathy.

If you have diabetes-related lower leg nerve damage that can increase the risk of limb loss, you can get a foot exam once per year (as long as you haven’t seen a footcare professional for a different reason between visits). This is covered by Part B.

Depending on your exam results, covered foot care may include treatment for foot ulcers and calluses and toenail management. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount and in a hospital outpatient setting, you also pay a co-pay.

Medicare will also cover shoes and inserts for people with diabetes since diabetic nerve damage can cause changes in the shape of your feet and toes, but a podiatrist or doctor must prescribe the shoes/inserts and they must be purchased directly from your provider or a medically licensed orthotist, pedorthist, or prosthetist.

How much does nail trimming cost?

Depending on the condition of your feet and whether you have diabetes, getting your toenails trimmed by a professional may be covered by Medicare. However, most beneficiaries will have to pay for their own trimming and care.

Toenail trimming at a nail salon can cost between $35 and $60 depending on whether you get other treatments such as exfoliation, cuticle trimming, fungus prevention, a foot massage, or others. When choosing a salon, make sure the pedicurist is reputable, has experience, and they sterilize all of their equipment.

If you must visit a podiatrist for routine foot care and it’s not covered by Medicare, the cost can range from $75 to $400 or more depending on the services you receive, the podiatrist you visit and where you live.

How to trim your toenails at home safely

If you are able to trim your own toenails, start by taking a bath, shower, or otherwise soaking your feet to soften the nail and make it easier to trim. Make sure your hands and feet are clean. Cut your toenails straight across and avoid cutting into the curve around the end of the nail. Also avoid cutting the skin, and never cut calluses.

When you’re finished, wash your hands and feet again and clean your trimming tools by washing them or wiping them with rubbing alcohol.

Additional resources

ClearMatch Medicare: Find a Medicare Plan
Medicare.gov: Foot Care
Medicare.gov: Care Compare

DONNA FREDERICK

After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.