Optometrist Preventive Care Health Insurance: Coverage and important examinations for your eye health
11 Apr 2025
11
Minutes
Katrin Straub
CEO at nextsure
The health of your eyes is precious, but which preventive examinations are covered by health insurance? Many people are unsure about the costs associated with ophthalmologist preventive services. This article highlights the cost coverage by health insurance and explains when you need to take action yourself.
The topic in brief and concise terms
Statutory health insurance covers costs for ophthalmologist visits when medically necessary; routine check-ups are often a self-paid service (IGeL).
The costs for individual health services (IGeL) such as early detection of glaucoma or AMD vary and should be clarified in advance; the benefits are sometimes disputed.
Regular eye exams (U-examinations) are covered by health insurance for children, but special screenings may incur additional costs.
Basics of Eye Care: What the Health Insurance Actually Covers
Statutory health insurance (GKV) covers the costs of ophthalmological examinations when there is a concrete suspicion of disease or medical complaints. A routine eye examination purely for preventive purposes for adults without specific risk factors or symptoms is often not included in the standard service catalog. Many preventive services, such as glaucoma screening for individuals under forty without risk factors, are classified as individual health services (IGeL). The costs for such IGeL can vary; for example, a glaucoma screening examination can cost between twenty and one hundred and forty euros. It is therefore important to inform yourself in advance about the scope of health services offered by your insurance. The precise distinction between services covered by insurance and those paid by the patient is a central issue for many patients.
IGeL at the eye doctor: A necessary investment or an expensive extra?
Individual health services (IGeL) are additional medical offers that go beyond the range of services covered by the statutory health insurance and must be paid for by the patient themselves. At the ophthalmologist, these often include early detection measures, such as retinal checks to prevent degeneration, which can cost between twenty-five and one hundred twenty euros. Extended glaucoma screenings using special measurement methods are also often included. The IGeL Monitor critically evaluates some of these services; for example, fundoscopy with intraocular pressure measurement for glaucoma early detection is rated as "tending to be negative" as the benefit is not always clearly demonstrated. An open discussion with your ophthalmologist about the medical necessity and individual benefit of an IGeL is therefore essential before you accept a cost estimate.
Here are some commonly offered IGeL services at the ophthalmologist and their approximate costs:
Intraocular pressure measurement for glaucoma early detection: twenty to forty euros.
Optical coherence tomography (OCT) for retina examination (outside specific diagnoses): eighty to one hundred fifty euros.
Retinal check for macular degeneration prevention: twenty-five to one hundred twenty euros.
Eye check for road users (visual acuity, field of vision, twilight vision): twenty-five to one hundred euros.
Contact lens fitting and check-up: costs vary widely, often from thirty euros.
These costs are only guidelines and can vary depending on practice and examination effort. Always clarify the exact costs in advance.
Glaucoma screening: When the insurance covers it and when you pay yourself
Glaucoma, also known as the Green Star, is a group of eye diseases that damage the optic nerve and can lead to blindness if untreated. Often, the disease goes unnoticed for a long period. Statutory health insurance covers the costs of diagnostic examinations when there is a justified suspicion of glaucoma or a diagnosis already exists. These include the measurement of intraocular pressure, assessment of the optic nerve head, and visual field examination. A routine screening for early detection of glaucoma without specific symptoms or risk factors, as recommended from the age of forty, is usually an IGeL and must be paid for privately. The Professional Association of Ophthalmologists (BVA) recommends glaucoma screening from the age of forty every two years. For individuals at higher risk, such as those with a family history or those with darker skin, earlier screening from the age of thirty is advised. A Health Check-up Insurance can help cover such costs. Weighing personal risk is crucial here.
Age-related Macular Degeneration (AMD): Understanding Prevention and Cost Coverage
Age-related macular degeneration (AMD) is a condition that affects the point of sharpest vision (macula) and is the most common cause of severe visual impairment in advanced age. The statutory health insurance covers the costs for early detection examinations if there is already a suspicion of AMD, symptoms appear, or specific risk factors such as a family history are present. Optical Coherence Tomography (OCT) is an important examination method and has been covered since January 2020 by statutory health insurance for patients with wet AMD and diabetic macular edema for up to six examinations per eye per year. If there are no individual risk factors, the early detection examination for AMD, recommended from the age of sixty, is usually billed privately as an IGeL. A supplementary health insurance can be a useful addition here.
An AMD screening examination may include the following steps:
Medical history and assessment of risk factors.
Vision test to check current visual acuity.
Amsler grid test for early detection of distortions.
Slit-lamp examination to assess the anterior and middle sections of the eyes.
Fundoscopy (eye background inspection) to inspect the retina and macula.
If necessary, an OCT examination for detailed cross-sectional images of the macula.
Early detection is crucial for treatment success.
Focus on Children's Eyes: These Check-Ups Are Crucial
The development of vision in children is a complex process, and undetected visual impairments can have far-reaching consequences for development. The costs for general preventative examinations (U-Untersuchungen) by the paediatrician, which also include basic eye tests, are covered by statutory health insurance. Since two thousand and seventeen, the children's guidelines include new regulations for the early detection of visual disorders as part of the U-Untersuchungen, such as tests for strabismus or cataracts during U4 to U7. Specific ophthalmic preventive examinations, like amblyopia screening, can be covered by health insurance under certain conditions (e.g., family history), but they are often individual health services (IGeL). The Professional Association of Ophthalmologists recommends a first ophthalmic examination at six months for those at increased risk (e.g., premature birth, family history of strabismus) and for all children between the ages of thirty-one and forty-two months. Vision aid insurance can also cover costs for special children's glasses. Timely ophthalmic assessments in children are crucial for healthy visual development.
Expert Tips: How to Navigate Eye Care Optimally
Deciding for or against an IGeL preventive examination at the ophthalmologist can be difficult. Our expert tip: Talk openly with your ophthalmologist about your individual risk profile and the necessity of the recommended examinations. Always clarify the costs in advance and ask about possible alternatives that may be covered by your health insurance. It might be sensible to consider a private health insurance or a suitable supplementary health insurance that also covers IGeL services. You make an informed decision best after comprehensive advice.
Ask your ophthalmologist the following questions to gain clarity:
What specific benefit does this preventive examination offer me personally?
Are there risk factors that make this examination particularly urgent for me?
What exact costs will I incur, and is there a detailed breakdown of charges (GOÄ codes)?
Are there alternative examination methods that are covered by statutory health insurance?
How often do you recommend this preventive examination for me?
What happens if an abnormal finding is detected during the examination? What follow-up costs could arise?
Good preparation for the doctor's consultation helps you make the right decisions for your eye health.
Conclusion: Proactive Planning for Healthy Eyes
Eye care check-ups are a vital component for the long-term preservation of your vision. While health insurance covers necessary medical treatments and examinations when there is a specific suspicion, many purely preventive measures fall within the realm of Individual Health Services (IGeL). Having a clear understanding of your health insurance benefits and maintaining open communication with your ophthalmologist is crucial. This way, you can make informed decisions and develop a preventive strategy that suits you. Remember, investing in your eye health pays off in the long run, often more than the mere treatment costs of perhaps only one hundred euros per year. nextsure supports you in finding the right coverage for your individual needs.
Request an individual risk analysis now: Have your insurance situation checked for free and receive concrete suggestions for optimisation.
More useful links
Wikipedia provides a comprehensive overview of ophthalmology.
The Techniker Krankenkasse (TK) offers information on the coverage of eye tests as an insurance service.
The consumer advice centre critically examines the billing of eye tests in ophthalmologist practices.
gesundheitsinformation.de, published by IQWiG, provides detailed information on various eye examinations.
The German Federation of the Blind and Partially Sighted (DBSV) presents current figures and facts on visual impairments in Germany.
The Week of Vision initiative provides statistics on eye diseases in Germany.
The Deutsches Ärzteblatt publishes an article on the prevalence of visual impairment in the adult population.
Statista offers statistics on eye diseases in children and adolescents, broken down by gender.
augeninfo.de, a joint initiative of the Professional Association of German Ophthalmologists (BVA) and the German Ophthalmological Society (DOG), offers comprehensive information on eye health.
FAQ
Does my health insurance cover the cost of a glaucoma screening?
The statutory health insurance covers the costs for a glaucoma examination if there is a specific suspicion or risk factors are present. A purely preventive examination without medical indication is usually an individual health service (IGeL) and must be paid for privately.
What are IGeL services at the ophthalmologist?
IGeL (Individuelle Gesundheitsleistungen) are examinations or treatments that are not covered by the statutory health insurance. At the ophthalmologist's, these often include enhanced preventive examinations such as specialised retinal scans (OCT without diagnosis), detailed early glaucoma detection, or vision tests for specific requirements (e.g. driving licence vision test).
At what age should one start precautionary measures against macular degeneration?
A screening examination for the early detection of age-related macular degeneration (AMD) is generally recommended from the age of 60. In cases of family history or other risk factors, it may be advisable to begin this from the age of 50.
Are eye exams for children free?
The vision tests conducted during the U-examinations at the pediatrician are covered by health insurance. Specific ophthalmological preventive check-ups or screenings for children may incur additional costs depending on the insurance provider and indication, or may be considered as individual health services (IGeL).
How can I protect myself from high costs for eye care check-ups?
Discuss the necessity and costs with your doctor before each examination. Clarify if it is covered by public health insurance or classified as an individual health service (IGeL). A private supplementary health insurance can help cover or reduce the costs of IGeL services.
Does the health insurance cover a new pair of glasses?
Statutory health insurance only provides a fixed subsidy for spectacle lenses in adults in exceptional cases, such as severe visual impairment (over six diopters) or certain eye diseases. Children and adolescents under 18 years of age generally receive a subsidy. For more information, see our article on <a href='/blog/gesetzliche-krankenversicherung-brille'>Brille von der Krankenkasse</a>.
