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statutory health insurance glasses
Statutory health insurance and glasses: How to secure your reimbursement
Many people who wear glasses wonder when the statutory health insurance covers the cost of glasses. The answer is often complex, but with the right knowledge, you can save real money. This article explains the requirements and offers practical tips.
The topic in brief and concise terms
Adults usually receive a subsidy for spectacle lenses from the statutory health insurance only in cases of severe visual impairment (e.g., over six diopters), while children under 18 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 by the individual.
A medical prescription is mandatory for the initial subsidy; supplementary insurance can help cover the remaining costs.
Quick Facts: Glasses and GKV – The Essentials in Brief
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, the costs for spectacle lenses are generally covered. The health insurance only subsidizes the lenses, not the frames. Fixed amounts apply, which can vary depending on the visual acuity.
Requirements for adults: When does the fund pay?
Adults receive a subsidy for eyeglass lenses from statutory health insurance only in cases of severe visual impairment. This applies to nearsightedness or farsightedness greater than six dioptres. If there is astigmatism, it must exceed four dioptres. Another prerequisite is a visual acuity of a maximum of thirty percent despite the best possible correction. The cost of the eyeglass frame must always be borne by adults themselves. For statutory health insurance, medical necessity is crucial. These regulations have been clarified by the Medical Aids Supply Act (HHVG) since 2017. A subsidy is also granted if the eyesight has changed by at least 0.5 dioptres.
The following conditions must be met for cost coverage for adults:
Nearsightedness or farsightedness: more than six dioptres
Astigmatism: more than four dioptres
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 is determined by nationwide fixed rates, which can range from ten to approximately 112 euros per lens. Remember that a prescription from an ophthalmologist is always required for the first prescription.
Children and adolescents: Better chances for cost coverage
For children and adolescents under 18 years of age, the regulations for covering the cost of glasses through statutory health insurance are much more generous. As a rule, the costs for the lenses are covered if there is a visual impairment. The dioptre values usually do not play a role in the basic entitlement, unlike for adults. The same applies here: the health insurance only covers the costs for the lenses, not for the spectacle frames. It is important to know that for children under 14 years of age, a new ophthalmologist's prescription is required for each change in correction values. For adolescents between 14 and 17 years of age, the optician can issue a follow-up prescription in the event of a change in vision after the initial prescription. An additional insurance for children's glasses can help cover the remaining costs. Even the lenses for sports glasses can be subsidised until compulsory education is completed.
The path to prescription glasses: explained step by step
To obtain a grant for your glasses from the statutory health insurance, you need to follow a few steps. First, a visit to the ophthalmologist is essential to have an eye test carried out and to receive a prescription for the glasses. This is particularly important for the initial prescription. The costs for this eye test at the doctor's are covered by the health insurance if medical necessity exists. Then, with the prescription, you go to an optician who is a contracted partner of your health insurance. The optician will advise you on suitable lenses and settle the fixed amount directly with the health insurance. You only pay the potential difference for higher quality lenses, the costs for the frame, and the statutory co-payment at the optician. The statutory co-payment amounts to ten percent of the insurance share, at least five euros and a maximum of ten euros per visual aid for adults. Prior approval by the health insurance is usually not required for the glasses. Do not submit an invoice retroactively, as this is usually not reimbursed. For a cost estimate at the health insurance, you should inform yourself in advance.
The necessary steps are:
Visit the ophthalmologist and have an eye test done.
If medically necessary, have a glasses prescription issued (not a private prescription).
Go with the prescription to a contracted optician of your health insurance.
Have your glasses adjusted and receive advice on any possible additional costs.
The optician settles the fixed amount directly with the health insurance.
You pay the remaining amount and the statutory co-payment at the optician.
Remember that the insurance only covers standard lenses; extras such as anti-reflective coatings or special hardenings usually have to be paid by you.
Supplementary Insurance: A Worthwhile Addition?
Since statutory health insurance often only covers a fraction of the costs for glasses, a private supplementary health insurance for visual aids might be a worthwhile option to consider. Such insurances can cover the costs for frames, higher quality lenses, special coatings or even contact lenses that are not paid for by the statutory health insurance. The benefits and premiums vary significantly between providers and tariffs. When choosing supplementary insurance, pay attention to the extent of reimbursement rates, any waiting periods, and annual limits. Many policies reimburse a certain amount every two years for a new pair of glasses. For families, a glasses insurance can be particularly interesting to offset the recurring costs for children's glasses. Compare the offers carefully to find insurance that suits your individual needs and budget. Good visual aid insurance can significantly reduce the financial burden.
Current Judgments and Developments in the Field of Visual Aids
The legal situation regarding the assumption of costs for visual aids by statutory health insurance is repeatedly the subject of court decisions. A ruling by the Federal Social Court on 19 April 2024 (Case No. B 3 KR 16/22 R) confirmed, for example, the entitlement of a squinting child with severe visual impairment to be provided with special bifocal plastic lenses, as therapeutic care was the priority here. In such therapeutic cases, the guideline for aids often does not impose restrictions on the refractive index of the lenses, unlike glasses that serve only to improve visual acuity. Another judgment clarified that even when receiving citizens' income, the claim against the health insurance for the repair of glasses is to be examined first if the medical conditions according to § 33 paragraph 2 sentence 2 number 2 SGB V are met (e.g., over seven diopters). It is advisable to stay informed about current judgments, as these can influence the interpretation of the laws. The ophthalmologist screening provided by the health insurance is an important component for the early detection of visual impairments. Developments such as the 2017 Act on the Provision of Medical Aids and Appliances (HHVG) have already led to adjustments, particularly for adults with severe vision impairments.
Optimise your supply: Contact us
The regulations regarding reimbursement for glasses by statutory health insurance can be complex. However, with the right information and good planning, you can assert your claims and save costs. Individual advice can help you find the best solution for your situation. At nextsure, we are happy to support you in navigating the insurance jungle and optimizing your coverage. Use our expertise for your eye health. Request an individual risk analysis now: Have your insurance situation checked for free and receive concrete optimization suggestions.
More useful links
Bundesgesundheitsministerium provides comprehensive information on aids in the German healthcare system.
GKV-Spitzenverband provides the official list of aids for statutory health insurances.
Wikipedia offers a detailed overview of statutory health insurance in Germany.
Verbraucherzentrale informs about the conditions under which health insurance funds cover the costs of new glasses.
Kassenärztliche Bundesvereinigung provides information on aids from a medical perspective and their prescription.
SGB V §33 contains the exact legal text regarding health insurance benefits for aids.
Gemeinsamer Bundesausschuss (G-BA) explains the guidelines and regulations on aids within the scope of prescribed services.
AOK provides information on their specific benefits for vision and hearing impairments, including visual aids and glasses.
Barmer offers detailed information on the coverage of costs for glasses and contact lenses by their health insurance.
Techniker Krankenkasse (TK) provides information on their services and the conditions for the coverage of costs for 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 lenses for adults under certain conditions, usually in cases of severe visual impairment (over six dioptres of nearsightedness/farsightedness, over four dioptres of astigmatism) or if the visual acuity, despite correction, is a maximum of thirty percent. For children and adolescents under 18 years, the costs for lenses are generally covered. The costs of the frame and extras like anti-reflective coatings are not covered. Fixed amounts apply to the lenses.
Do I always need a prescription from the ophthalmologist for glasses?
Yes, for the initial subsidy of lenses by statutory health insurance, a prescription (medical order) from an ophthalmologist is always required. For subsequent prescriptions for adults, an optometrist's refraction measurement may be sufficient if the values have changed by at least 0.5 dioptres. For children under 14 years, a new prescription from the ophthalmologist is always necessary.
How much is the health insurance subsidy for lenses?
The health insurance pays a fixed amount for lenses. This amount depends on the visual strength and type of lens and typically ranges between ten and 112 euros per lens. You have to cover the remaining costs for more expensive lenses and the costs for the frame and extras yourself.
Does the health insurance also cover the costs for contact lenses?
The costs for contact lenses are only covered by statutory health insurance in medically necessary exceptional cases, such as very high dioptre values (often over eight dioptres), certain eye diseases, or when glasses cannot be worn. The costs for care products are never reimbursed.
What about workplace or computer glasses?
The costs for special workplace or computer glasses are not covered by statutory health insurance. Usually, the employer is obliged to cover these costs if the necessity exists according to occupational health and safety regulations.
Can I deduct the costs for my glasses from taxes?
Yes, the costs for glasses you have paid for yourself can be claimed in the tax return as an exceptional burden if they exceed the reasonable burden limit.
