Are orthotics usually covered by insurance?

Asked by: Tobin Bogisich  |  Last update: December 15, 2023
Score: 4.4/5 (75 votes)

Generally, orthotics are covered if:
They are considered medically necessary and prescribed to treat a diagnosed medical condition covered under the health benefit plan. The orthotics are prescribed by a qualified medical practitioner for protection, support, pain relief, and body alignment.

How often will insurance cover orthotics?

If your plan covers orthotics at all, it will typically allow you to get another pair after a certain period of time has passed. Often, this is one new pair per year, but sometimes the waiting period is longer.

How much can I expect to pay for orthotics?

There are many types of custom orthotics, and they can cost anywhere from $300 to $800. Semi-custom orthotics cost between $60 and $300, and basic off-the-shelf inserts are available for as little as $10 to $20. Some health insurance plans won't pay for custom-made orthotics.

Should I go to a podiatrist for orthotics?

If the over the counter arch support does not fix your foot pain, you need to see a podiatrist. Podiatrists are the experts when it comes to foot and ankle health. They can prescribe a custom orthotic for you.

Do I need a prescription for an orthotic?

Although some doctors give prescriptions for orthotics, you don't need a medical prescription for custom orthotics. You can order them online.

Are Orthotics Covered By Insurance?

17 related questions found

Why are orthotics covered by insurance?

Orthotics can eliminate the need for long-term dependency on medication, physical therapy, or surgery. Consequently, many insurance plans consider orthotics as therapeutic medical devices and provide coverage.

What are signs you need orthotics?

7 Signs You Need Orthotics
  • You have foot pain or swelling. ...
  • You have sharp heel pain. ...
  • You have a flat foot or high arch. ...
  • You're having problems with balance or are falling over. ...
  • Your shoes are wearing unevenly. ...
  • You've had a lower limb injury. ...
  • You have diabetic foot complications.

Who should prescribe orthotics?

Complete Podiatric Evaluation

Only a doctor or a podiatrist can diagnose and prescribe foot orthotics.

How often do foot orthotics need to be replaced?

While a typical custom orthotic might last around 2-3 years on average, not every case is a typical one. Some people need theirs replaced every year, while others can get 5 years or more (occasionally much more) of use out of theirs. In other words, it really is a case-by-case thing.

Do orthotics hurt at first?

The short answer is no; though there can be an adjustment period when using new foot orthotics, they are custom-designed for each patient and are intended to help your feet, not hurt them.

Why are foot orthotics so expensive?

Unlike over-the-counter insoles, which are generic and can be easily purchased by walking into a store, different types of custom orthotics are specially designed to fit a particular foot and address specific foot conditions. Because of this, they tend to be more expensive compared to over-the-counter orthotics.

What happens at first orthotics appointment?

Your first appointment

At the initial appointment, the Orthotist assesses you, discusses your condition and decides on the most appropriate device.

How long does it take to get fitted for orthotics?

You should have your fitting appointment approximately four to six weeks after your initial orthotic assessment. Shoes may require two fitting appointments, so this means it will be approximately eight to twelve weeks before your shoes are supplied.

How many hours should you wear orthotics?

Wear your ICON ORTHOTICS a total of 2 - 4 hours today, and increase the time you wear them by 1 – 2 hours a day. It usually takes one to two weeks to become completely used to wearing your orthotics but this time can differ from person to person. Most people can wear the orthotics full time in 3-5 days.

Do you wear orthotics for life?

If you have conditions like flat feet, very high arches, or bunions, which are usually lifelong conditions, you may need to wear orthotics in your shoes indefinitely. Doing this will be the most effective way to conservatively manage any conditions from worsening with age.

Can you wear orthotics all day?

There is no such thing as wearing them too much, but at some point, your podiatrist may say that it is alright to stop wearing them, or only to wear them during certain activities. Generally, you should wear custom orthotics whenever possible, but there are times when it matters more than others.

Why do my feet still hurt with custom orthotics?

If you are still feeling pain or discomfort after 2-3 weeks, visit your podiatrist to adjust your orthotics. If you have generic store-bought variations, perhaps consider visiting a podiatrist for a complete gait analysis and some custom-made orthotics. Take proper care of your orthotics.

What are the side effects of custom orthotics?

Why You May Feel Pain and Discomfort After Wearing Orthotics
  • Improper footwear. Wearing orthotic insoles with improper footwear can do more harm than good. ...
  • Poorly designed (or fitted) orthotics. ...
  • Not breaking in your orthotic properly. ...
  • Increased soreness. ...
  • Altered mechanics. ...
  • Compensatory injuries. ...
  • Loss of sensation. ...
  • Too Stiff.

Can orthotics be moved from shoe to shoe?

Often custom made foot orthotics can be transferred between similar types of shoes. For example, the orthotic that is made for your running shoes will likely fit in your walking or hiking shoes. However, the same orthotic may not fit, or be as effective in, a pair of lady's dress shoes, sandals, skis or skates.

What to look for when buying orthotics?

Look for an orthotic that is inflexible with good arch support. Push down on the arch. If it collapses under finger pressure, it is not rigid enough. Note that this type of orthotic may feel strange when first worn because of its rigidity and shape.

What should an orthotic prescription include?

It is important to understand and apply prescription parameters related to orthotic shape and positive cast work. This section of the orthotic prescription includes heel cup depth, orthotic width, cast fill, medial skive and positive cast inversion.

Can anyone get custom orthotics?

Find a provider with years of experience fabricating custom orthotics to make sure yours are done right. Unless you have a complex foot disorder, are diabetic, are a high- performance athlete, or have a recurring injury that over-the-counter insoles can't address, you likely don't need custom orthotics.

What is the difference between orthotics and orthotic?

Orthotics, also known as orthoses and orthotic insoles, are placed in shoes to restore natural function to the feet. Orthopedic shoes are designed to relieve pain and provide support for your feet, ankles or legs. Here is a look at orthotics and orthopedic shoes and what they can do for you.

Why are custom orthotics better than over the counter?

With every foot being different, over the counter orthotics companies produce orthotics to fit the general public. They tend to evenly distribute the stress on the foot while custom made foot orthotics work to reduce the overall fatigue placed on the foot.

Why do podiatrists recommend orthotics?

Clinical research studies have shown that podiatrist-prescribed foot orthotics decrease foot pain and improve function. Orthotics typically cost more than shoe inserts purchased in a retail store, but the additional cost is usually well worth it.