Breakdown of FSA and HSA Benefits

Everyday living costs certainly can add up for your patients. From home care and foot expenses to daily necessities and health care, everything adds up.

Fortunately for your patients, some footwear is considered eligible when using Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) — which can be a great cost-savings tool. Whether looking for athletic footwear or dress shoes, Dr. Comfort® offers a wide array of diabetic and therapeutic shoes for those with foot-health issues.

If your patients are wondering how FSAs and HSAs, then use this breakdown to help them understand what’s covered.

What's the difference between an FSA and an HSA?

FSA's and HSAs are pre-tax accounts they can use to pay for healthcare-related expenses, such as diabetic footwear. Usually, an HSA health-care plan has a high-paying deductible.1

An FSA is like a line of credit. For example, if their account balance is $50 in January but they'd like to buy a $200 pair of prescription eyeglasses, they can as long as they're on track to save at least $200 by the end of the year. So your patients are covered throughout the year. However, if they don't use it the funds they could lose it.

An HSA is a health savings account. So your patient can put money into a savings account that is only for healthcare. The money that's saved always stays in that account. Keep in mind they can only spend money they've already saved.

With both FSA's and HSAs, your patients can pay for things like co-payments, medical bills, and health-care expenses. And both accounts have benefits that can make managing out-of-pocket medical expenses easier throughout the year.

Both have pros and cons. An FSA has a little less flexibility—and must be offered through an employer—while an HSA has a bit of flexibility, but an HSA may have more out-of-pocket costs.2 Regardless, both allow your patients to save for medical costs. Your patients may want to map out their medical costs for the year and figure out how much they'll want to put away in their FSA or HSA to cover any expectant costs. Learn more about HSAs and FSAs here.

Can patients use an HSA or FSA to purchase Dr. Comfort shoes?

Dr. Comfort® shoes with A5500 HCPCS (Healthcare Common Procedure Coding System)3 are eligible. In order to get reimbursed for A5500 HCPCS shoes, they'll be asked to submit the following documentation, but not limited to:

1) Prescribing physician's detailed written order

2) Completed signed and dated statement from the certifying physician (physician managing the beneficiary's systemic diabetes condition) specifying that the beneficiary has diabetes and:

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 is being treated under a comprehensive plan of care for his/her diabetes, and needs diabetic shoes.

3) Relevant medical records where the certifying physician either personally documented that the beneficiary met one or more of criteria 2a – 2f or obtained documentation from another clinician documenting the beneficiary met one or more of criteria 2a – 2f and the certifying physician indicated agreement with the information by initialing and dating the record

4) Supplier in-person evaluation conducted prior to the selection of items that documents an examination of the beneficiary's feet with a description of the abnormalities that will need to be accommodated by the shoes/inserts/modification

5) An in-person visit, at the time of delivery, which assesses the fit of the shoes and inserts with the beneficiary wearing them

6) Delivery documentation with the beneficiary's name and address and the description of the items provided

7) Any other pertinent records.

Relevant medical records consist of physician notes, non-physician clinical notes, and non-physician clinical evaluations that verify that the patient's condition meets coverage criteria for therapeutic shoes for persons with diabetes. The source of these records may be a physician's office, hospital, nursing home, home health agency, wound clinic, etc. Evaluations used to determine coverage must have been performed and recorded prior to delivery and performed by a clinician who does not have a financial relationship with the supplier.3

Dr. Comfort® shoes are American Podiatric Medical Association (APMA) approved, meaning the shoes are constructed with technology, material, and craftsmanship to deliver comfortable and top-quality diabetic shoes. The designs and materials are made to help protect the feet and help prevent them from foot-health issues that are associated with diabetes and other foot health problems.

From exploring the town and outdoor adventures to special occasions and work, your patient's footwear can be considered a medical aid, which can help them save on their diabetic and foot-health costs.

Shop A5500 HCPCS footwear.

Remember to speak with your health care provider and health insurance for more information.

The contents of this blog were independently prepared, and are for informational purposes only. The opinions expressed herein are those of the author and are not necessarily indicative of the views of any other party. Individual results may vary depending on a variety of patient-specific attributes and related factors.

Sources

Breakdown of FSA and HSA Benefits

What's the difference between an FSA and an HSA?

Can patients use an HSA or FSA to purchase Dr. Comfort shoes?

Shop A5500 HCPCS footwear.

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