Does Medicare Cover Ingrown Toenails?
- Learn about Medicare's coverage and the amount it pays for ingrown toenail surgery and other foot problems, including those issues treated by a podiatrist.
Does Medicare cover ingrown toenails? It depends. Medicare covers many treatments for the feet, including services provided by podiatrists. Take a look at the specific foot-related services that Medicare does (and doesn't) cover, including ingrown toenail issues.
Does Medicare Cover Ingrown Toenails?
Ingrown toenails occur when a toenail grows downward, pushing into the skin, rather than growing straight. Most often this occurs with the big toe. The experience of an ingrown toenail can be very painful as the toenail pushes into the soft tissue around it. Ingrown toenails can occur as a result of poor grooming, shoes that don't fit well or genetics.
Many people are able to treat ingrown toenails at home, soaking their feet in warm, soapy water to soften the toenail so it can be trimmed appropriately. However, in some cases, it's necessary to see a podiatrist or physician for treatment. The podiatrist typically removes the ingrown section of the nail. If you experience chronic ingrown toenails, your health care provider may use chemicals or lasers to remove the offending corner of the nail.
Anyone with diabetes or circulation issues should see a podiatrist or physician for treatment of an ingrown toenail right away, as the toenail problems may be part of larger issues.
Medicare covers ingrown toenail treatments and procedures if a podiatrist or physician considers them medically necessary. If the ingrown toenail is treated while you are admitted to a hospital, Medicare Part A will cover it. If you are treated as an outpatient, your ingrown toenail procedure is covered under Medicare Part B. See below for specifics on the covered and non-covered costs.
What Podiatry Services Does Medicare Cover (and What Does It Not Cover)?
Medicare covers many podiatry services, especially for people who have been diagnosed with nerve damage related to diabetes. That's because diabetes often damages the nerves in the feet and legs, so people with diabetes must make sure they get proper foot care. In addition, Medicare will cover certain podiatric services if a health care provider has deemed them medically necessary.
Among the podiatry services that Medicare covers are:
- Custom-molded therapeutic inserts or shoes. Medicare may cover these for people with diabetes if considered medically necessary.
- Treatment for toenail fungus. This treatment, called nail debridement, may be covered if you have experienced multiple infections and are in severe pain.
- Medicare may cover prosthetic devices as well as bracing for the ankles, feet and knees. These are considered durable medical equipment and covered under Medicare Part B.
- Bunion treatments. If your doctor deems treatment medically necessary, Medicare may cover bunion inserts and pads, toe spacers and even bunion removal surgery.
- Hammertoe surgery. Medicare covers hammertoe surgery if your doctor deems it essential for your health.
- Foot problems related to major medical conditions. In addition to foot problems stemming from diabetes, Medicare will also cover diagnosis and treatment of foot issues resulting from cancer, chronic kidney disease, multiple sclerosis and vein inflammation related to blood clots.
In addition, Medicare also pays for a foot test every six months for people with diabetes or diabetic peripheral neuropathy, as well as loss of sensation in the feet due to other causes. However, this foot test is not available if you have seen a podiatrist or other foot care specialist during that six-month period for another reason.
In all of the above cases, your podiatrist or physician must provide evidence that the care is medically necessary.
Medicare does not cover routine foot care unless it's medically necessary. For example, Medicare will cover toenail clipping by a podiatrist if it would be hazardous to your health unless a podiatrist handled the procedure. In most cases, though, toenail clipping is not covered.
Other routine foot care procedures that are not covered by Medicare include:
- Removal of calluses
- Removal of corns
- Cleaning and soaking the feet
- Flat foot treatments
- Other preventative maintenance of the foot
If you have Medicare Advantage (Medicare Part C) coverage, it's likely that your visit to a podiatrist is covered — but only if you use an in-network provider. If you go to a podiatrist who is out of network, you will have to pay part or all of the bill yourself. Before you go to a podiatrist, make sure the provider is in your Medicare Advantage network and get a referral from your doctor to see the podiatrist.
What Does Ingrown Toenail Surgery Cost (and What Will Medicare Pay for?)
Ingrown toenail surgery typically costs between $200 and $500. If your ingrown toenail surgery is covered by Medicare, you will have to pay 20% of the total cost. For example, if your podiatrist charged $350 for the surgery, your out-of-pocket share would be $70. In addition, if you have not fulfilled your deductible to Medicare Part B for the year, you will have to pay those costs.