Plantar fasciitis is a common source of foot discomfort, characterized by inflammation and pain along the thick band of tissue connecting the heel bone to the toes. Navigating the cost of treatment often leads patients to question their health coverage. Generally, treatments for this condition are covered by the federal health program when the care is deemed medically necessary for diagnosis or recovery. Specific services and devices must meet certain standards for payment to apply.
How Medicare Part B Addresses Treatment
The primary coverage for outpatient medical care, which includes most treatments for plantar fasciitis, is handled through the medical insurance portion of the program (Part B). This coverage focuses on services a physician determines are necessary to diagnose or treat an illness or injury.
Coverage extends to visits with enrolled specialists, such as a podiatrist or an orthopedic doctor. Diagnostic services, including X-rays or laboratory tests ordered to rule out other causes of heel pain, are also included. These initial appointments establish the medical necessity for subsequent treatments.
Once the diagnosis is confirmed, coverage is provided for active treatment modalities. This includes professional physical therapy services focused on stretching and strengthening exercises. If the treatment plan requires corticosteroid injections, the cost of the drug and the procedure is typically covered, provided the service meets accepted standards of medical practice.
Rules for Supportive Devices and Equipment
Coverage for devices used to support the foot and alleviate plantar fasciitis symptoms is governed by distinct rules, often classifying them as durable medical equipment (DME) or other supportive items. Devices must be prescribed by a participating physician and obtained from an approved supplier. The eligibility of the device depends heavily on its nature and the specific medical context.
Custom-molded orthotics are highly conditional. They are generally not covered solely for treating simple plantar fasciitis, as they are classified as supportive devices for the feet. An exception is made if the orthotics are required as part of a treatment plan for conditions like severe diabetic foot disease or after complex foot surgery.
Over-the-counter or prefabricated shoe inserts designed for general arch support are typically not covered, as they are not considered medically necessary therapeutic items. Other DME items, such as a night splint or a walking boot prescribed for recovery, are covered if they meet medical necessity criteria. Patients should confirm that the specific device and supplier meet all program requirements before acquisition.
Patient Financial Responsibility and Advantage Plans
While the program covers medically necessary treatments, the beneficiary retains certain financial responsibilities. For covered services, the annual deductible must first be met before the program begins to pay its share. After the deductible is satisfied, the patient is responsible for a coinsurance amount, typically 20 percent of the approved cost for the service. The remaining 80 percent of the approved amount is paid by the program. If the services are provided in an outpatient hospital setting, a separate copayment may also apply, which varies depending on the specific facility.
These costs apply across all covered services and equipment, including doctor visits, injections, and eligible DME. People who receive benefits through a private plan, often called an Advantage Plan, must receive coverage for plantar fasciitis that is at least equivalent to the federal program.
However, these private plans structure cost-sharing differently, often substituting the standard coinsurance with varying copayment amounts for different services. Advantage Plans utilize provider networks, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Patients must confirm their provider is in-network to avoid higher out-of-pocket costs.