Health & Care
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ophthalmologist preventive care health insurance
Eye Doctor Preventive Care Health Insurance: Coverage and Important Examinations for Your Eye Health
The health of your eyes is invaluable, but which preventive examinations are covered by health insurance? Many people are uncertain about the costs associated with ophthalmological preventive services. This article sheds light on the health insurance coverage and indicates when you need to take action yourself.
The topic in brief and concise terms
Statutory health insurance covers ophthalmologist costs in cases of medical necessity; routine preventive care is often a self-pay service (IGeL).
The costs for IGeL services such as glaucoma or AMD early detection vary and should be clarified in advance; the benefits are partially disputed.
Regular eye examinations (U-Untersuchungen) are covered by insurance for children, but special screenings may incur additional costs.
Essentials of Eye Care: What the Health Insurance Actually Covers
The statutory health insurance (GKV) covers the costs for ophthalmological examinations when there is a specific suspicion of illness or medical complaints are present. A routine eye examination purely for preventive purposes in 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 the age of forty without risk factors, are considered Individual Health Services (IGeL). The costs for such IGeL can vary; for instance, a glaucoma screening examination can cost between twenty and one hundred and forty euros. Therefore, it is important to inform yourself in advance about the scope of the health services provided by your insurance. Clearly distinguishing between insurance-covered services and self-paid services is a central issue for many patients.
IGeL at the eye doctor: Necessary investment or expensive extra?
Individual health services (IGeL) are additional medical services that go beyond the statutory health insurance scheme and must be paid for by the patient. At the ophthalmologist, these often include early detection measures, such as a retinal check to prevent degeneration, which can cost between twenty-five and one hundred and twenty euros. Extended glaucoma screening using special measurement methods is also often included. The IGeL-Monitor critically assesses some of these services; for instance, eye examination with intraocular pressure measurement for early glaucoma detection is rated as "tending to be negative" because the benefit is not always clearly proven. An open conversation with your ophthalmologist about the medical necessity and individual benefit of an IGeL is therefore essential before accepting a cost estimate.
Here are some commonly offered IGeL services at the ophthalmologist and their approximate costs:
Intraocular pressure measurement for early glaucoma detection: twenty to forty euros.
Optical coherence tomography (OCT) for retinal examination (outside specific diagnoses): eighty to one hundred and fifty euros.
Retinal check for macular degeneration prevention: twenty-five to one hundred and twenty euros.
Eye check for drivers (visual acuity, visual field, twilight vision): twenty-five to one hundred euros.
Contact lens fitting and control: costs vary greatly, often starting at thirty euros.
These costs are only guidelines and can vary depending on the practice and the extent of the examination. Always clarify the exact costs in advance.
Glaucoma Screening: When the Insurance Pays 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 left untreated. Often, the condition goes unnoticed for a long time. The statutory health insurance covers the costs of diagnostic examinations if there is a justified suspicion of glaucoma or if a diagnosis has already been made. These include measuring intraocular pressure, assessing the optic nerve head, and a visual field test. A pure preventive examination 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 every two years starting at the age of forty. For individuals with increased risk, such as those with a family history or people of color, earlier screening from the age of thirty is advised. A health check-up insurance can help cover such costs. Weighing up personal risks is crucial here.
Age-related macular degeneration (AMD): Understanding prevention and cost coverage
Age-related macular degeneration (AMD) is a condition that affects the area of sharpest vision (macula) and is the most common cause of severe vision impairment in older age. The statutory health insurance covers the costs of early detection examinations if there is already a suspicion of AMD, symptoms occur, or specific risk factors such as a family history are present. Optical coherence tomography (OCT) is an important diagnostic method and has been covered by statutory health insurance for patients with wet AMD and diabetic macular oedema since January 2020 for up to six examinations per eye and 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 a self-paid health service. A supplementary health insurance can be a sensible addition here.
A preventive examination for AMD may include the following steps:
Medical history and identification 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 segments of the eyes.
Fundoscopy (ophthalmoscopy) to inspect the retina and macula.
Possibly an OCT examination for detailed cross-sectional images of the macula.
Early detection is crucial for treatment success.
Expert tips: How to navigate eye care optimally
Deciding for or against an IGeL preventative examination at the ophthalmologist can be difficult. Our expert tip: Talk openly with your ophthalmologist about your individual risk profile and the necessity of recommended examinations. Always clarify the costs in advance and ask about possible alternatives that might be covered by your health insurance. It may be worthwhile to consider private health insurance or a suitable supplementary health insurance that also covers IGeL services. The best way to make an informed decision is after comprehensive consultation.
Ask your ophthalmologist the following questions to gain clarity:
What specific benefit does this preventative examination have for 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 billing basis (GOÄ figures)?
Are there alternative examination methods that are covered by statutory health insurance?
How frequently do you recommend this preventative examination for me?
What happens if an abnormal finding is detected during the examination? What follow-up costs could arise?
Being well-prepared for the doctor's conversation helps you make the right decisions for your eye health.
Conclusion: Proactive Planning for Healthy Eyes
Eye doctor preventative care is an important component for the long-term preservation of your eyesight. While the health insurance covers necessary medical treatments and examinations when there is a specific suspicion, many pure prevention measures fall into the category of IGeL. A thorough understanding of your health insurance services and open communication with your ophthalmologist are crucial. This allows you to make informed decisions and develop the preventive strategy that suits you best. Remember that investments in your eye health pay off in the long run, often more than the pure treatment costs, which might only amount to a hundred euros per year. nextsure supports you in finding the right coverage for your individual needs.
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More useful links
Wikipedia provides a comprehensive overview of ophthalmology.
The Techniker Krankenkasse (TK) provides information on the coverage of vision tests as a health insurance benefit.
The Verbraucherzentrale offers a critical look at the billing of vision tests in ophthalmologists' practices.
gesundheitsinformation.de, published by IQWiG, offers detailed information on various eye examinations.
The Deutsche Blinden- und Sehbehindertenverband (DBSV) provides current figures and facts about visual impairments in Germany.
The initiative Woche des Sehens provides statistics on eye diseases in Germany.
The Deutsche 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), provides comprehensive information on eye health.
FAQ
Does my health insurance cover the costs for a glaucoma screening?
The statutory health insurance covers the costs for a glaucoma examination if there is a strong suspicion or risk factors are present. A preventive screening without a medical indication is usually an IGeL and must be paid for privately.
What are IGeL services at the ophthalmologist?
IGeL (Individual Health Services) are examinations or treatments not included in the statutory health insurance's service catalogue. At the ophthalmologist, these are often extended preventive screenings 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 macular degeneration screening?
A screening for the early detection of age-related macular degeneration (AMD) is generally recommended from the age of 60. In cases of family predisposition or other risk factors, it may be advisable from the age of 50.
Are eye examinations for children free of charge?
The vision tests carried out as part of the U-examinations at the paediatrician are covered by health insurance. Specific ophthalmological preventive examinations or screenings for children may incur additional costs depending on the insurance and indication or be considered IGeL.
How can I protect myself from high costs for ophthalmologist screenings?
Before each examination, talk to your doctor about the necessity and costs. Clarify whether it is a service covered by insurance or an IGeL. A private supplementary health insurance can help to cover or reduce the costs for IGeL services.
Does the health insurance pay for new glasses?
Statutory health insurance only provides a fixed allowance for adult lenses in exceptional cases, e.g., in cases of severe visual impairment (over six dioptres) or certain eye diseases. Children and adolescents under 18 years typically receive an allowance. More information can be found in our article on Glasses from the Health Insurance.
