Does Medicare Cover Nail Fungus?
This article was updated on: 09/10/2018
If you have nail fungus, you’re not alone. According to the Mayo Clinic, nail fungus is common, especially in older adults. Nail fungus results in nails that are thickened, discolored, brittle and ragged, and slightly foul smelling. Nail fungus can affect the fingernails, but it’s more common in the toenails.
What is nail fungus treatment?
According to the Mayo Clinic, nail fungus can be difficult to treat and even after successful treatment nail fungus often comes back.
You may start with over-the-counter nail cream or ointment. If that doesn’t work, there are several prescription medications available including oral antifungal drugs, medicated nail polish, and medicated nail cream.
In some cases, your doctor may recommend surgery as nail fungus treatment. Surgery could temporarily remove the nail so antifungal medication can be applied directly under the nail. Surgery also might involve permanent nail removal if the infection is severe.
Does Medicare cover nail fungus?
Medicare covers limited podiatry. Medicare may cover nail fungus treatment if it’s determined to be medically necessary foot care. According to the Mayo Clinic, nail fungus may lead to a serious infection that spreads beyond your feet if you have a suppressed immune system. People with diabetes are particularly at risk for complications from nail fungus. In other people, nail fungus could be a mild condition causing no problem beyond the cosmetic.
Medicare does not generally cover routine foot care, including removal of corns and calluses or trimming of toe nails. If treatment of your nail fungus is considered cosmetic or routine, Medicare usually will not cover it.
Does Medicare Part D cover nail fungus medications?
For most prescription drug coverage to treat nail fungus, you will need Medicare Part D coverage. You can get Part D coverage through:
- A stand-alone Medicare Part D Prescription Drug Plan that works alongside Original Medicare (Part A and Part B).
- A Medicare Advantage plan with prescription drug coverage. Medicare Advantage is another way to get your Original Medicare benefits. Medicare Advantage must cover everything that Original Medicare covers, with the exception of hospice care which is still covered by Medicare Part A.
To find out if your prescription drug plan covers nail fungus medication, check the plan’s formulary, or list of covered medications. The formulary may change at any time, but the plan will inform you when necessary.
Medicare Part D prescription drug plans do not usually cover over-the-counter medications such as over-the-counter nail fungus creams and ointments.
Do you have more questions about Medicare coverage?
I can help you find a Medicare plan that may cover foot care and nail fungus. You can schedule a phone call or request an email by clicking one of the links below, or click the Compare Plans button to see a list of plan options in your area you may qualify for.