Yes, arch supports can be covered by insurance when they’re prescribed for a diagnosed condition, but store-bought inserts are often excluded.
Arch supports show up as retail insoles and as billed medical devices, so plan rules can feel confusing.
This guide shows when a plan may pay and how to check benefits before you buy. It’s general information, not medical or insurance advice.
Are Arch Supports Covered By Insurance?
Plans tend to pay for arch supports only when they fall under a defined orthotic benefit and meet “medical necessity” rules. In plain language, that means the device is meant to treat a diagnosed problem and improve function, not just add comfort in a shoe.
The quickest way to think about this is to sort arch supports into two buckets:
- Retail inserts: off-the-shelf insoles you grab by shoe size.
- Custom orthotics: made from a mold or scan of your foot and billed with medical codes.
Retail inserts may help, yet many plans don’t reimburse them. Custom orthotics have better odds when the claim follows plan rules.
| Plan Or Payment Route | What Usually Must Be True | Typical Member Cost Pattern |
|---|---|---|
| Employer or union health plan | Orthotics are a listed benefit; diagnosis + prescription; in-network supplier | Deductible, then coinsurance or a device copay |
| Marketplace (ACA) plan | Same medical-necessity rules; tighter networks; authorization is common | Higher out-of-network cost or no out-of-network pay |
| Medicare Part B | Limited pathways; therapeutic shoes and inserts can be paid for certain diabetes-related foot needs | After deductible, you usually pay 20% of the allowed amount |
| Medicaid | Rules vary by state; prior approval and enrolled suppliers are common | Low cost-share, yet strict paperwork |
| Workers’ compensation | Device ties directly to a work injury with treatment notes | Often $0, with case-manager paperwork |
| Auto injury benefits | Must tie to an injury claim and a treatment plan | Often $0 up to policy limits |
| Health FSA or HSA | Qualified medical purpose; keep receipts; a letter of medical need may help | You pay upfront, then reimburse yourself |
| Self-pay | Best when your plan excludes orthotics or your deductible is high | Full price, with full control over where you buy |
Arch Supports Covered By Insurance By Plan Type
Private health plans
Private plans usually ask three questions: Is there an orthotics benefit at all, is the device medically necessary for a diagnosis, and did you follow the plan’s channels? If any of those is “no,” the claim can fail even when the insert helps your pain.
Medicare
Medicare pays through defined benefits, such as the therapeutic shoe benefit for qualifying diabetes-related foot conditions. Details and yearly limits are on Medicare therapeutic shoes & inserts.
Medicaid
Medicaid is state-run, so rules change by location. Prior approval is common. Supplier enrollment can be strict, so buying retail and submitting later may not work.
Injury claims
Workers’ compensation and auto injury benefits run as injury files. Notes must link the device to the injury and the plan of care. When approved, you may owe little or nothing.
What Makes Payment More Likely
Documentation that links to function
Plans pay for function, not comfort. Ask your clinician to document the diagnosis plus limits like standing time, walking distance, and repeat flare-ups.
A prescription and a qualified supplier
Many plans require a prescription or order. Some also require the device to be dispensed by an in-network clinic, a certified orthotist, or another contracted provider type. If the supplier is out-of-network, the claim may be reduced or rejected.
The right code and the right timing
Custom orthotics are billed with HCPCS codes. Ask what code will be used, then call your insurer to ask if that code is paid for your diagnosis. Ask if authorization is needed and get the approval number first.
Proof the device is custom
Plans that pay for orthotics often want proof the device was made from a mold or scan. Keep the itemized invoice and any record of the casting or scanning visit.
What Gets Denied Most Often
Retail inserts
Retail arch supports can be treated like shoes and socks: personal items with no reimbursement. Submitting a store receipt with no prescription can trigger an automatic denial.
Missing authorization
If your plan says “authorization required,” treat it like a stop sign. Approval must be on file before the device is ordered or picked up.
Wrong supplier path
Even a custom device can be denied if the supplier isn’t contracted for your exact plan or if the provider type doesn’t match the benefit rules. “In-network with the brand” isn’t enough. You want in-network with your plan name.
Limits and timing
Many plans pay for one pair, then lock you out until a set time passes. If you replace early, you can get denied as “not due.” If the old pair broke, photos and a short clinician note can help justify replacement.
How To Check Your Benefits In 10 Minutes
- Find your plan document: look in your member portal for your certificate or evidence document.
- Search for terms: “orthotics,” “foot orthotics,” “shoe inserts,” and “arch supports.”
- Read three spots: the benefit section, the exclusions list, and the limits section.
- Get the billing code: ask your clinic what HCPCS code they expect to bill.
- Call the insurer: ask if that HCPCS code is paid for your diagnosis and if authorization is required.
- Confirm your cost: ask about deductible status, coinsurance, and any dollar cap for orthotics.
- Save proof: write down the date, rep name, and reference number.
Use a simple script on the phone: “Is HCPCS code ____ paid for diagnosis ____? Is authorization required? What’s my cost share?” That usually gets you a straight answer.
Paperwork To Gather Before You Buy
- Prescription or order with diagnosis and device description.
- Clinic notes that show symptoms, exam findings, and what you tried first.
- Authorization approval number and dates, if required.
- Itemized invoice listing the device, the code, and the supplier’s NPI or tax ID.
- Proof of payment if you paid upfront.
Using FSA, HSA, Or A Tax Deduction
If your plan won’t pay, a health FSA or HSA may still help, since those accounts can reimburse many qualified medical purchases. If you itemize deductions, some out-of-pocket medical expenses may count toward your Schedule A total. The IRS explains the rules in IRS Publication 502.
Appeal Steps That Work When A Claim Is Denied
A denial isn’t always the final answer. Many plans allow an internal appeal, and some allow an outside review. The trick is to tie your evidence to the plan’s own wording, not to personal opinions about comfort.
| Appeal Step | What To Send | Timing Cue |
|---|---|---|
| Read the denial letter | Point to the reason code and the plan section named in the letter | Start fast so you don’t miss the appeal window |
| Get the policy used | Ask for the medical policy or guideline the reviewer applied | Get it before writing your appeal |
| Build a tight packet | Prescription, notes, casting proof, invoice, and any authorization record | Use a one-page front sheet listing what’s included |
| Add a clinician letter | A letter linking the device to diagnosis, function limits, and failed prior care | Ask for plain language plus diagnosis codes |
| Fix claim errors | Correct missing fields, dates, or codes and resubmit when allowed | Best for “incomplete information” denials |
| File the internal appeal | Your letter plus packet plus a copy of the denial letter | Use portal upload or tracked mail |
| Ask about outside review | Follow the plan’s steps for a third-party review, if offered | Do it after an internal denial |
Keep your appeal tight and match each attachment to the plan rule named in the denial letter.
Cost Math That Helps You Decide
Retail insoles might be $15–$60. Custom orthotics often run $300–$800. Even when a plan pays, you may still owe deductible and coinsurance, and the plan’s allowed amount can be lower than the billed amount.
To estimate your cost, ask for the allowed amount for the HCPCS code, your remaining deductible, and your coinsurance rate for orthotics. Then check if there’s a dollar cap. A cap can leave you paying the difference even after approval.
When Paying Out Of Pocket Can Still Make Sense
Sometimes the cleanest route is self-pay: your plan excludes orthotics, you’re early in a high deductible year, or you want to test a lower-cost insert first. If you buy retail, pick a shop with a return window and keep the packaging.
Quick Checklist Before You Spend
- Confirm the plan has an orthotics benefit and that your diagnosis fits its rules.
- Get the HCPCS code and ask if authorization is required.
- Use an in-network supplier if your plan limits supplier choice.
- Keep a packet: order, notes, invoice, and proof the device is custom.
- If denied, appeal with the plan rule in hand and evidence matched to it.
And yes, one more time: are arch supports covered by insurance? They can be, yet the path matters. Do the quick checks above and you’ll know the answer before you swipe your card.
If you want extra certainty, send your insurer a written message through the member portal: “are arch supports covered by insurance? If so, which codes, limits, and authorization rules apply?” A written reply can help if a claim later goes sideways.