Statutory health insurance and glasses: How to ensure your cost reimbursement
6 Apr 2025
10
Minutes
Katrin Straub
CEO at nextsure
Many people who wear glasses wonder when the statutory health insurance covers the cost of spectacles. The answer is often complex, but with the right knowledge, you can save real money. This article explains the requirements and provides practical tips.
The topic in brief and concise terms
Adults usually receive a subsidy for spectacle lenses from the statutory health insurance only if they have a severe visual impairment (e.g. over six dioptres), while children under 18 years generally always do.
The statutory health insurance only covers the cost of standard spectacle lenses up to a fixed amount; frames and extras must be paid for separately.
A medical prescription is absolutely necessary for the initial subsidy; supplementary insurance can help cover the remaining costs.
Quick Facts: Glasses and GKV – The Essentials at a Glance
The coverage of glasses by statutory health insurance is clearly regulated. Adult insured persons usually bear the costs themselves, unless there is a significant visual impairment. For children and adolescents under 18 years, the costs for the lenses are generally covered. The health insurance only subsidises the lenses, not the frames. There are fixed amounts which can vary depending on the prescription strength.
Requirements for adults: When does the insurance pay?
Adults receive subsidies from statutory health insurance for spectacle lenses only in cases of severe visual impairment. This applies to short- or long-sightedness of more than six diopters. If there is a corneal curvature (astigmatism), it must be more than four diopters. Another requirement is a vision capability of at most thirty percent despite best possible correction. Adults must always bear the costs for the spectacle frame themselves. For statutory health insurance, medical necessity is decisive. These regulations have been clarified by the Medical and Rehabilitation Supplies Act (HHVG) since 2017. A subsidy is also granted if the visual acuity has changed by at least 0.5 diopters.
The following conditions must be met for cost coverage for adults:
Short- or long-sightedness: over six diopters
Corneal curvature: over four diopters
Maximum visual acuity with correction: less than or equal to thirty percent
Therapeutic visual aids for eye injuries or diseases
The exact amount of the subsidy depends on nationwide fixed amounts, which can range from ten to approximately 112 euros per lens. Remember that an eye doctor's prescription is always necessary for the first prescription.
Children and adolescents: Better chances of cost coverage
For children and adolescents under 18 years of age, the regulations regarding the coverage of glasses by statutory health insurance are significantly more generous. In principle, the costs for the lenses are covered if a visual impairment exists. Unlike adults, the diopter values usually do not play a role in the fundamental entitlement. The same rule applies here: the health insurance covers only the cost of the lenses, not the spectacle frame. It is important to know that for children under 14, a new ophthalmologist's prescription is required for every change in correction values. For adolescents between 14 and 17 years old, the optician can issue a follow-up prescription after the initial prescription if there is a change in vision. An additional insurance for children's glasses can help cover the remaining costs. Until the completion of compulsory schooling, even the lenses for sports glasses can be subsidised.
The path to prescription glasses: Explained step by step
To receive a subsidy for your glasses from statutory health insurance, you must follow some steps. First, a visit to the ophthalmologist is essential to have an eye test and to receive a prescription for the glasses. This is especially valid for the initial prescription. The costs for this eye test at the doctor are covered by the health insurance if there is a medical necessity. With the prescription, you then go to an optician who is a contractual partner of your health insurance company. The optician will advise you about the suitable lenses and will directly settle the fixed amount with the health insurance. You only pay the possible difference for higher quality lenses, the cost for the frame, and the statutory co-payment to the optician. The statutory co-payment is ten per cent of the insurance's share, at least five euros and a maximum of ten euros per visual aid for adults. Prior approval from the health insurance is usually not required for glasses. Do not submit an invoice afterwards, as this is generally not reimbursed. For a cost estimate at the health insurance, you should inquire beforehand.
The necessary steps are:
Visit an ophthalmologist and have an eye test.
Have a glasses prescription issued if there is a medical necessity (not a private prescription).
Go to a contract optician of your health insurance with the prescription.
Have the glasses fitted and be advised about possible additional costs.
The optician settles the fixed amount directly with the health insurance.
You pay the remaining amount and the statutory co-payment to the optician.
Do not forget that the insurance only covers standard lenses; extras like anti-reflective coatings or special hardenings usually have to be paid for by you.
Expert Depth: Flat Rates, Special Cases, and Other Important Aspects
The reimbursement amount for spectacle lenses by statutory health insurance is based on fixed amounts. These are determined by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) and are uniform nationwide. Fixed amounts vary depending on the type and strength of the lenses needed, and can range from around ten euros to 112 euros per lens. Our expert tip: Specifically ask your optician for lenses that are fully covered by the fixed amount to minimise additional payments. The cost of the spectacle frame is generally not covered by the statutory health insurance. Even for extras such as anti-reflective coatings, tints, or particularly thin lenses, policyholders must pay themselves, unless a higher level of provision is medically necessary and certified. A glasses insurance policy can be a useful addition here. For contact lenses, subsidies are only available in very limited medical exceptional cases, for example, in cases of intolerance to spectacle lenses or very high dioptre values (often over eight dioptres). The cost of care products for contact lenses is never covered. Occupational glasses (VDU workstation glasses) are not covered by the statutory health insurance; here the employer is usually responsible if the requirements according to occupational health and safety regulations are met. Some health insurance companies offer subsidies for glasses as part of bonus programs or as a voluntary statutory benefit that goes beyond the regular statutory provision; it is worth enquiring with your insurance company. The upper limit of statutory health insurance does not directly relate to aids such as glasses, but to contribution assessment limits.
Supplementary Insurance: A Worthwhile Addition?
Since statutory health insurance often only covers a fraction of the cost of glasses, a private supplementary health insurance for visual aids can be a worthwhile option. Such insurance can cover the costs of frames, high-quality lenses, special coatings, or even contact lenses that are not covered by the public health insurance. The benefits and premiums vary significantly between providers and plans. When choosing supplementary insurance, pay attention to the reimbursement rates, any waiting periods, and annual limits. Many plans, for instance, reimburse a certain amount for new glasses every two years. For families, glasses insurance can be particularly appealing to offset the recurring costs of children's glasses. Compare the offers carefully to find insurance that meets your individual needs and budget. Good visual aids insurance can significantly reduce the financial burden.
Current Judgments and Developments in the Field of Visual Aids
The legal situation regarding the coverage of visual aids by statutory health insurance is repeatedly the subject of court decisions. A judgment of the Federal Social Court on 19 April 2024 (Ref. B 3 KR 16/22 R) confirmed, for instance, the entitlement of a child with strabismus and severe vision impairment to receive special bifocal plastic lenses, as therapeutic care was the priority in this case. The directive on aids often does not impose restrictions on the refractive index of the lenses in such therapeutic cases, unlike glasses that only serve to improve visual acuity. Another judgment clarified that even when receiving citizen's income, the claim against the health insurance for repair of glasses must be examined first, if the medical requirements of § 33 paragraph 2 sentence 2 number 2 SGB V are met (e.g., over seven dioptres). It is advisable to stay informed about current judgments, as they can influence the interpretation of laws. Eye care by health insurance is an important component for the early detection of vision impairments. Developments such as the Heil- und Hilfsmittelversorgungsgesetz (HHVG) of 2017 have already led to adjustments, particularly for adults with severe visual impairments.
Optimise your supply: Contact us
More useful links
Bundesgesundheitsministerium provides comprehensive information on aids within the German healthcare system.
GKV-Spitzenverband offers the official directory of aids from statutory health insurers.
Wikipedia provides a detailed overview of statutory health insurance in Germany.
Verbraucherzentrale informs about the conditions under which health insurers cover the cost of a new pair of glasses.
Kassenärztliche Bundesvereinigung provides information on aids from a medical perspective and their prescription.
SGB V §33 contains the exact legal text regarding the benefits of health insurers for aids.
Gemeinsamer Bundesausschuss (G-BA) explains the guidelines and regulations for aids within the scope of provisioned services.
AOK provides information on their specific services for visual and hearing impairments, including visual aids and glasses.
Barmer provides detailed information on the coverage of costs for glasses and contact lenses through their health insurance.
Techniker Krankenkasse (TK) provides information on their services and the conditions for covering the costs of glasses and contact lenses.
FAQ
Which costs for glasses are covered by statutory health insurance?
The statutory health insurance (GKV) only covers part of the costs for spectacle lenses for adults under certain conditions, usually in cases of severe visual impairment (more than six dioptres for short-/farsightedness, more than four dioptres for astigmatism) or if visual acuity is no more than thirty percent despite correction. For children and adolescents under 18, the cost of spectacle lenses is generally covered. The costs for the spectacle frame and extras such as anti-reflective coatings are not covered. Fixed rates apply for the lenses.
Do I always need a prescription from an optician for glasses?
Yes, an initial prescription from an ophthalmologist is always required for the first-time subsidy of spectacle lenses by the statutory health insurance. For repeat prescriptions in adults, a refraction determination by an optician may suffice if the values have changed by at least 0.5 dioptres. For children under 14 years, a new prescription from an ophthalmologist is always necessary.
What is the health insurance subsidy for spectacle lenses?
The health insurance covers a fixed amount for spectacle lenses. This amount depends on the prescription strength and the type of lens and typically ranges between ten and 112 euros per lens. You will need to cover the remaining cost for more expensive lenses as well as for the frame and any extras yourself.
Does the health insurance also cover the cost of contact lenses?
The cost of contact lenses is only covered by statutory health insurance in medically essential exceptional cases, for example, with very high dioptre values (often above eight dioptres), certain eye diseases, or when glasses cannot be worn. The cost of care products is never reimbursed.
What about workplace glasses or computer glasses?
The costs for special workplace or screen glasses are not covered by the statutory health insurance. Typically, the employer is responsible when the necessity arises according to occupational health and safety guidelines.
Can I deduct the cost of my glasses from my taxes?
Yes, the costs for a self-paid pair of glasses can be claimed as an extraordinary burden in the tax return, provided they exceed the reasonable burden limit.
