Does Medicare Cover Nail Fungus Treatment?

Toenail fungus is an infection of the toenails that causes white or yellow spots to develop on the nail. The medical term for nail fungus is onychomycosis. In many cases, mild cases of toenail fungus can resolve on their own as the nail grows out or with home remedies. However, if the infection spreads deep into the nail, medical intervention may be required. Individuals with underlying health issues that compromise the immune system may be at especially high risk of the infection traveling to areas outside of the nail bed. 

Does Medicare Cover Nail Fungus Treatment?

In general, routine foot care is not covered by Medicare. However, Medicare will typically cover podiatrist visits for individuals with diabetes-related nerve conditions and those with foot diseases or injuries. If a podiatrist detects a toenail fungus infection that requires medical treatment, Medicare Part B, Original Medicare and Medical Advantage plans may cover a portion of any medically necessary treatments. 

Depending on the specifics of the treatment plan and insurance plan, recipients may be required to pay a portion of the cost: around 20% for podiatry treatments. Medicare Advantage plans may also provide additional benefits, so it's important for beneficiaries to inquire with Medicare to determine what is covered. 

When toenail fungus infections require prescription medications, Medicare Part D and stand-alone prescription drug plans through Original Medicare may help cover some or all of the costs. 

Does Insurance Cover Laser Treatment for Toenail Fungus?

Medicare Part B covers "medically necessary" services like doctor visits and outpatient care for toenail fungus diagnosis and treatment. However, Original Medicare typically pays only 20% of the Medicare-approved cost, with the Part B deductible applying.

For medication prescribed for toenail fungal infection, enrollment in Part D prescription drug coverage is necessary. A stand-alone Prescription Drug Plan (PDP) under Original Medicare can also help with the costs. Routine foot care is generally not covered, except for individuals with diabetes-related nerve conditions, foot diseases, or injuries. In such cases, podiatrist visits for toenail fungus may be covered under Medicare Part B, Original Medicare, or Medical Advantage plans.

Nail Fungus Explained

Toenail fungus is common among individuals of all ages, but older adults with underlying health conditions such as diabetes or immune disorders may develop more serious infections. Older adults tend to be more prone to nail fungus because of the natural aging of the nails, which can cause brittleness and dryness. When dry nails become cracked, fungus can enter more easily. Common risk factors for toenail fungus include:

• Minor skin or nail injuries that allow fungus to enter the nail
• Being an older adult with diabetes
• Environments that cause feet to sweat heavily, sometimes coupled with tight-fitting shoes
• Walking through damp communal areas barefoot, such as gym locker rooms or indoor swimming pool areas

Nail Fungus Symptoms

In some cases, people with nail fungus may be completely unaware of their condition while others may experience severe symptoms, such as bacterial skin infections, as the fungus spreads. Common symptoms of nail fungus include:

• Misshapen nails
• Nails that easily separate from the nail bed
• Pain exuding from the nail area
• Unusual odor surrounding the nail.
• Crumbling nails
• Nail discoloration, usually white, yellow or brown

What Are the Most Effective Medical Treatments for Toenail Fungus?

Nail fungal infections that travel deep into the nails can be hard to treat, and specific treatments may vary depending on the type of fungus involved and whether or not the infection has spread. Some common medical treatments that are considered effective in treating toenail fungus include prescription antifungal oral medications that encourage new nail growth, medicated nail polishes, medicated nail creams and surgical procedures to remove severely infected toenails.

What Are Best Prescriptions for Nail Fungus?

Oral antifungals are considered the best prescription medications to treat toenail fungus from the inside out, especially for individuals with severe infections. Common oral prescriptions include terbinafine (Lamisil) and itraconazole. Terbinafine is considered the best oral medication, as it causes less side effects than other medications and can resolve fungal infections approximately 76% of the time. 

Additional oral prescriptions include fluconazole (Diflucan) and noxafil, an oral liquid. Itraconazole is the least popular among oral prescriptions as it causes significant side effects such as headache, nausea and breathing difficulties in certain cases. 

The best prescription topical creams for toenail fungus include efinaconazole and tavaborole. These medications are applied topically to the affected toenails once a day for a period of 48 weeks. 

What Are the Complications of Untreated Toenail Fungus?

While difficult to treat in some instances, toenail fungus is treatable and individuals should take all necessary steps to treat infections to prevent further issues. Complications of untreated toenail fungus include the spread of the infection to surrounding nails and bacterial infections (cellulitis) of the skin. Cellulitis causes severe inflammation of the surrounding skin and must be treated immediately with antibiotics. 

Can Toenail Fungus Grow Out?

Toenail fungus does not usually resolve on its own without some sort of medical intervention. However, with treatment, the infected nails will eventually grow out and healthy nails will grow in their place. It's important to note that it can take as long as 18 months for new nails to grow in and for infections to clear.