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does Medicare cover toenail fungus treatment

Does Medicare Cover Toenail Fungus Treatment?

The chances of getting a toenail fungus is higher in seniors. That is especially true with seniors who have chronic medical conditions or severe underlying conditions. This includes diabetes and immunodeficiency problems. There are a number of types of treatment for toenail fungus including laser treatment.

If you are looking to treat this medical issue, a common question you likely have is, “does Medicare cover toenail fungus treatment?” In this article, we answer that question in clear, plain English. You will also find the average costs of treatment for toenail fungus if you have to pay for it yourself.

Does Medicare Cover Toenail Fungus Treatment?

The short answer is yes. Medicare will cover the cost of treatment for toenail fungus. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your treatment for toenail fungus. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for treatment for toenail fungus. Medicare Parts A and B do not provide coverage for routine foot services and care. However, Original Medicare provides coverage for podiatry services like tests and treatment if it is considered medically necessary, such as treatment for toenail fungus.

Coverage for treatment for toenail fungus is provided by Medicare Part B. Medicare Part B provides coverage for treatment for toenail fungus since, most of the time, it takes place in an outpatient setting. For toenail fungus treatment, Medicare Part B provides coverage for doctor’s/podiatrist’s visits, outpatient care, diagnosis, and treatment.

Medicare Part B also provides coverage toenail fungus treatments such as toenail debridement as well as laser treatment. Toenail debridement is the removal of a dead nail as well as debris of an infected nail. 

Medicare Part B covers 80 percent of the costs of treatment for toenail fungus. You will pay for the remaining 20 percent. 

Part C and Part D Coverage for Toenail Fungus Treatment

Medicare Advantage plans (Medicare Part C) also provide coverage for treatment for toenail fungus. These plans have to provide coverage for everything Original Medicare does. However, they’ll also provide coverage from some things that Original Medicare does not cover. Exactly what a Part C plan covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you to treat your toenail fungus.

Aside from treatments like laser treatment and nail debridement, another way of treating toenail fungus is through prescription medication. Medicare Part D plans provide coverage for toenail fungus medications. Medicare Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Treatment For Toenail Fungus Cost?

Over-the-counter medications for treating toenail fungus cost less than $20. Generic oral medications cost less than $100. On the other hand, brand-name oral antifungal medications can be a little expensive. These types of medications can cost $500 or more. 

Laser treatment for toenail fungus can cost $1,000 or more.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover life vest defibrillators?

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