Orthopedic insoles, or foot orthotics, may be covered by Social Security and private insurance plans, such as mutual health insurance companies. However, this coverage is subject to certain conditions that must be met to maximize insurance reimbursement.
What does Social Security offer?
To be eligible for reimbursement, a prescription from your primary care physician is required. Social Security covers 60% of the Social Security Reimbursement Base (BRSS), depending on the price of the insoles, with frequency limits:
· For adults (age 16 and older): one pair reimbursed per year.
· For children (under 16): one pair every six months.
The reimbursement rate also varies depending on shoe size:
· Sizes smaller than 28: €25.88 per pair
· Sizes 28–37: €28.04 per pair
· Sizes larger than 37: €28.86 per pair
For example, for someone who wears a size 40, if the attending physician has prescribed an orthotic insole, the insurance coverage is €17.31 (which is 60% of €28.86).
The Role of Health Insurance Cooperatives
The remaining portion may be covered by your health insurance, depending on the coverage provided by your policy. Reimbursement options vary:
· Annual allowance: Some health insurance plans cover a fixed amount (for example, between €50 and €200 per year).
· Reimbursement percentage: Some plans apply a reimbursement rate ranging from 100% to 500%. For example, a pair of orthopedic insoles costing €28.86 could be reimbursed up to €144.30, depending on the plan.
It is therefore essential to review your health insurance coverage to reduce out-of-pocket costs.
Special coverage for people with diabetes
Some health insurance providers offer specific plans for people with diabetes that cover the full cost of orthotics. This coverage is designed to prevent complications related to foot conditions and may include regular visits to podiatrists.
Although Social Security provides initial coverage, it is often your supplemental health insurance that makes the difference. By comparing plans and tailoring your policy, you can maximize your coverage and take full advantage of reimbursement for your orthotics.
