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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Orthopedic shoes and other supportive devices for the feet generally are not covered. However, this exclusion 
does not apply to such a shoe if it is an integral part of a leg brace, and its expense is included as part of the 
cost of the brace. Also, this exclusion does not apply to therapeutic shoes furnished to diabetics. You can find 
this rule in the Medicare Benefit Policy Manual, Chapter 15, Section 290(3). 
 
Therapeutic shoes, inserts and/or modifications to therapeutic shoes are covered if all of the following criteria 
are met: 
 
    1. The beneficiary has diabetes mellitus (Reference diagnosis code section below); and 
    2. The certifying physician has documented in the beneficiary's medical record one or more of the following 
conditions:  
        Previous amputation of the other foot, or part of either foot, or 
        History of previous foot ulceration of either foot, or 
        History of pre-ulcerative calluses of either foot, or 
        Peripheral neuropathy with evidence of callus formation of either foot, or 
        Foot deformity of either foot, or 
        Poor circulation in either foot; and 
    3. The certifying physician has certified that indications (1) and (2) are met and that he/she is treating the 
beneficiary under a comprehensive plan of care for his/her diabetes and that the beneficiary needs diabetic 
shoes. For claims with dates of service on or after 01/01/2011, the certifying physician must: 
        Have an in-person visit with the beneficiary during which diabetes management is addressed within 6 
months prior to delivery of the shoes/inserts; and 
        Sign the certification statement (refer to the Policy Specific Documentation Requirements section below) 
on or after the date of the in-person visit and within 3 months prior to delivery of the shoes/inserts. 
    4. Prior to selecting the specific items that will be provided, the supplier must conduct and document an in-
person evaluation of the beneficiary. (Refer to the Policy Specific Documentation Requirements section 
below.) 
    5. At the time of in-person delivery to the beneficiary of the items selected, the supplier must conduct an 
objective assessment of the fit of the shoe and inserts and document the results. A beneficiary's subjective 
statements regarding fit as the sole documentation of the in-person delivery does not meet this criterion.  
You can find this information in Local Coverage Article: Therapeutic Shoes for Persons with Diabetes - Policy 
Article (A52501). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The Plan 
contract also says that diabetic shoes and inserts are covered for people with diabetes who have severe diabetic 
foot disease. You can find this information on page 4-13 of the Plan's 2020 Evidence of Coverage.