Does Health Insurance Cover Toenail Fungus?

  • The typical out-of-pocket cost for foot fungus treatment for those with health insurance is a 10% -50 percent copay or coinsurance. Depending on the plan, foot fungus treatment at a doctor’s office and prescription drugs are usually covered by health insurance.
  • Fungus therapy can range from less than $20 for over-the-counter topical treatments or generic oral meds to less than $100 for prescription topical medications and up to $500 or more for brand-name oral antifungal medications for people without health insurance. Laser therapy for nail fungus might cost up to $1,000. Costs for certain fungal illnesses like eumycetoma, which are uncommon in the United States, can exceed $20,000 or more in exceptional situations.
  • If oral antifungal drugs fail to treat a rare fungal illness like eumycetoma, amputation can cost $20,000 or more.
  • Athlete’s foot is often treated with a topical antifungal cream, ointment, or spray that can be purchased over-the-counter. A doctor can prescribe a stronger topical or oral drug such itraconazole (brand name Sporanox) or terbinafine (brand names Lamisil or Terbinex) if it does not respond to treatment, or if the patient has diabetes or is in discomfort. Athlete’s foot treatment is described in detail by the Mayo Clinic.
  • The most common therapy for nail fungus is an oral medicine called terbinafine (brand names Lamisil or Terbinex), which is administered once daily for 12 weeks. The healthy nail can take several months to grow in. Antifungal lacquer and other topical treatments are available, but they are ineffective and can take a year or longer to act. The Mayo Clinic provides a treatment summary for nail fungus.
  • Additional treatment will be required if athlete’s foot or nail fungus recurs. To avoid recurrence or dissemination to others, wear cotton socks during therapy, change them frequently, and wash socks and towels in very hot water.
  • Uninsured/cash-paying patients can receive savings of up to 35 percent or more from hospitals and doctors. UC Health in Cincinnati, for example, gives a 40% discount.
  • On their websites, some podiatrists provide discounts. Primera Podiatry in Atlanta, for example, presents a monthly special that offers discounts on laser toenail fungus treatment.
  • Foot fungus can be treated by a family doctor or a podiatrist. A doctor locator is available from the American Medical Association. A podiatrist locator is also available from the American Podiatric Medical Association. Depending on their area of practice, ensure sure the podiatrist is certified by the American Board of Podiatric Medicine or the American Board of Podiatric Surgery.

Does medical cover toe fungus?

In general, Medicare does not cover routine foot treatment. Individuals with diabetes-related nerve issues, as well as those with foot disorders or injuries, are usually covered by Medicare for podiatrist visits. If a podiatrist identifies a toenail fungal infection that necessitates medical treatment, Medicare Part B, Original Medicare, and Medical Advantage insurance may cover a portion of the costs.

Recipients may be asked to pay a percentage of the cost, which is typically around 20% for podiatrist treatments, depending on the specifics of the treatment plan and insurance plan. Additional benefits may be provided by Medicare Advantage plans, so beneficiaries should check with Medicare to see what is covered.

When toenail fungal infections necessitate the use of prescription medications, Original Medicare Part D and stand-alone prescription drug plans may be able to assist cover part or all of the costs.

How much does it cost to cure toenail fungus?

When trying to cure toenail fungus, the expenditures can add up quickly, and it’s not always clear which drug to use. The cost of treating one nail can range from over $2,000 to as little as $10 for a medication that heals all ten toes but may have negative side effects. Then there are the expensive lab tests to determine that the curling yellow rot biting through a toenail is mold.

A drug called terbinafine is now the most effective treatment for toenail mold or onychomycosis. A full treatment, which can take up to six months, costs around $10. According to a research published in JAMA Dermatology on Wednesday, it would be more cost-effective to give the medicine to everyone who clinicians suspect has toenail fungus rather than investing extra money to confirm the diagnosis in a lab, which may cost up to $148.

Given that at least 10% of Americans have toe fungus, the researchers estimate that avoiding the tests might save the health-care system between $18 million and $90 million.

Do you need a prescription for toenail fungus?

To treat toenail fungus that won’t go away with over-the-counter or natural therapies, prescription drugs are frequently required. To treat onychomycosis, your doctor may prescribe a topical antifungal cream or medicated nail lacquer. Individuals suffering from toenail fungus can also take antifungal tablets orally.

Topical medication

In the treatment of mild to moderate toenail fungus, topical medicines are fairly successful. Medicated nail lacquers, lotions, and liquid pharmaceuticals are examples of topical solutions. Some of the most commonly given medications for toenail fungus include Loprox, Penlac, and Jublia.

Jublia

Jublia (efinaconazole) is an antifungal that is used to treat toenail fungus on a topical basis. Jublia is administered once daily (for 48 weeks) to the afflicted area with a brush applicator that comes with the prescription. Jublia contains efinaconazole in a 10% topical solution that has been approved by the Food and Drug Administration (FDA).

Penlac

In an 8% topical solution, Penlac includes ciclopirox. It is applied to the damaged nail and surrounding skin once daily at bedtime, in both generic and brand forms. Rubbing alcohol should be used to remove it once a week. During treatment with this drug, a healthcare expert should remove the infected, detached nail as often as once a month.

Oral medication

Internal drugs are an alternative to external medications for toenail fungus treatment. Sporanox (itraconazole) and Lamisil (terbinafine) are two examples of systemic onychomycosis drugs that can be taken orally.

Sporanox

Sporanox (itraconazole) is a capsule that is used to treat onychomycosis. The capsule should be taken with a full meal and eaten whole. Consult your doctor or pharmacist and read any labels to ensure that you are aware of all risk factors and that you are taking your prescription correctly.

Lamisil

Lamisil is commonly thought of as a topical OTC solution, however it can also be administered as an oral medication. Prescription Lamisil can be used for six weeks (for the fingernail) to twelve weeks (for the toenail) or even longer to treat tinea. If you have severe toenail fungus, talk to your doctor about taking Lamisil orally.

A word of caution: oral antifungal drugs have several drug interactions and can be extremely harmful, if not lethal, when taken with other prescriptions. Sporanox, for example, can interact with the antibiotic Biaxin (clarithromycin) and cause an arrhythmia (irregular heartbeat). Before using an oral antifungal, talk to your doctor or pharmacist about your current medications.

Does toenail fungus indicate health problems?

A severe case of nail fungus can be unpleasant and ruin your nails permanently. If your immune system is compromised due to medicine, diabetes, or other illnesses, it might lead to other deadly infections that spread beyond your feet.

Does health insurance cover laser for toenail fungus?

The most effective technique to treat a fungal nail infection is with toenail laser therapy. Unfortunately, because it is considered “aesthetic,” medical insurance does not currently cover this surgery. There are, however, several options for lowering the expense of laser therapy.

Will removing my toenail get rid of the fungus?

For severe or recurring fungal nail infections, surgical nail removal is an option. It is possible to remove the complete nail (avulsion) or merely a portion of the nail (debridement). A clinic or your doctor’s office can do surgical nail removal. To relieve pain, your doctor will inject it into your finger or toe.

What kills toenail fungus fast?

Because they eliminate the illness faster than topical treatments, these drugs are frequently the primary choice. Terbinafine (Lamisil) and itraconazole are two options (Sporanox). These medications aid in the growth of a new nail that is free of infection, gradually replacing the infected portion. This sort of medication is usually taken for six to twelve weeks.

How do you get rid of toenail fungus fast?

Toenail fungus can be killed using hydrogen peroxide. With a clean cloth or cotton swab, wipe hydrogen peroxide directly on your diseased toes or toenails. In a foot soak, hydrogen peroxide can also be employed.

How do you get prescribed toenail fungus?

To cure a toenail fungus infection, you can’t normally buy toenail fungus treatments online because many of them require a prescription. Toenail fungus drugs that require a prescription must be obtained from a licensed pharmacist, either online or in person. When it’s appropriate, Push Health can connect you with a registered medical provider who can prescribe toenail fungus drugs, such as generic toenail fungus lotions and toenail fungus tablets, to help with toenail fungus treatment.

What happens if you leave toenail fungus untreated?

The initial indicators of a fungal nail infection are usually visible changes in the diseased nail’s appearance (s). Although it is rare for an infected nail to cause significant discomfort or permanent disfigurement, it does happen occasionally. If left untreated, fungal nail infections can make walking, exercising, and performing manual jobs like typing difficult. The main signs and symptoms of onychomycosis include:

These signs and symptoms could potentially indicate that a person has nail psoriasis, a persistent autoimmune skin condition that affects the skin beneath the nail. Fingernail psoriasis is more frequent than toenail psoriasis, and it can co-occur with nail fungal infections.

Good to know: Fungal toenail infections can raise the risk of ulceration and other complications in persons with diabetes, thus medical help should always be sought if a fungal nail infection is suspected.

Types of onychomycosis

Tinea unguium, or onychomycosis, is caused by a buildup of dermatophyte fungi. These are parasitic fungi that infect the skin and nails and must live in the bodies of humans and animals to survive. Dermatophytes burrow under the nails to reproduce, causing fungal infections of the nails.

Trichophyton rubrum, the most frequent form of fungus to infect the nails, and trichophyton interdigitale fungi are two types of dermatophytes that commonly cause fungal nail infections. Yeasts, such as candida albicans, and molds, such as scopulariopsis brevicaulis, are other fungi that can cause fungal nail infections.

What is proximal subungual onychomycosis?

Trichophyton rubrum is the most common cause of infection. Infection begins at the proximal nail fold (the base of the nail) and spreads up the newly created nail plate, unlike other types of fungal nail infection.

People with a weakened immune system are more likely to develop proximal subungual fungal nail infection. Human immunodeficiency virus (HIV) proximal subungual onychomycosis is a clinical sign for the infection (HIV).