Nail fungus affects millions of people, but many go months or even years without getting treatment. Toenail fungus commonly affects seniors with chronic medical conditions or more serious underlying conditions. Diabetes, circulatory problems, or immune-deficiency conditions can contribute to toenail fungus which is caused by an infection under the surface of the nail. It can lead to discomfort, pain, and may impair your ability to walk if left untreated.

Many people don’t recognize the symptoms of toenail fungus, including white marks on the nail bed, distorted shape, discoloration, or a thickening of the nail.  It may affect one or several nails, and can affect ambulatory and non-ambulatory patients. If you notice any changes in the appearance of your nails, you should make an appointment with your physician. Patients with a lowered immune system due to illness or medications may be at risk of the infection spreading beyond the nail area.

Will Medicare Insurance Pay for Treatment? Although Medicare does not generally cover routine foot care, Medicare usually includes coverage for podiatrist foot exams or treatment if you have diabetes-related nerve damage or need medically necessary treatment for foot injuries or diseases. A podiatrist can detect a fungal infection, make a diagnosis and develop a treatment plan. Treatments will vary based on the severity of the infection and may include prescribing topical or oral medication, and in severe cases, may include debridement, which is the removal of diseased nail and debris of an infected nail.

How Medicare Can Help Medicare Part B (Medical Insurance) may help cover medically necessary services, including doctor visits and care you receive in an outpatient setting, to diagnose and treat infections such as toenail fungus. If you have Original Medicare, you would likely pay 20% of the Medicare-approved amount and the Part B deductible will apply. If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same coverage as Original Medicare, but many MA plans offer additional benefits.

If your podiatrist prescribes medication to help treat your fungal infection, you will need to be enrolled in Part D prescription drug coverage to get help paying for it. If you have Original Medicare, your stand-alone Prescription Drug Plan (PDP) may help cover the costs. Many Medicare Advantage plans include prescription drug coverage, often referred to as an MA-PD, but every drug plan can have its own formulary, or list of covered drugs. Each PDP or MA-PD will also have its own tiers of pricing based on generic, brand-name, or mail order medications.

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