Laser treatment for farsightedness: optimising health insurance coverage
14/04/25
11
Minutes
Katrin Straub
Managing Director at nextsure
Are you dreaming of a life without reading glasses, but are unsure whether your health insurance will cover laser treatment for your long-sightedness? Many people affected face this question. This article takes a closer look at your options and shows you ways to obtain financial support.
The topic in brief and concise terms
Statutory health insurance funds (GKV) only cover the costs of laser treatment for long-sightedness in rare exceptional cases; private health insurers (PKV) are often more accommodating, depending on the tariff.
A 2017 Federal Court of Justice ruling strengthens the rights of private health insurance policyholders regarding coverage of the costs of eye laser surgery, as visual impairment is regarded as an illness and the operation as medical treatment.
The cost of laser eye surgery for long-sightedness per eye is often between eight hundred and three thousand euros; obtaining a quote in advance and clarifying matters with private health insurance is essential.
Insurance Coverage Realities: Statutory Health Insurance vs Private Health Insurance for Laser Treatment for Farsightedness
Covering the costs of laser treatment for long-sightedness by health insurance is a key issue for many affected people. As a rule, statutory health insurance (GKV) does not usually cover the costs of refractive surgery such as laser eye treatment for long-sightedness. This is because the procedure is usually considered not medically necessary as long as correction with glasses or contact lenses is possible. An exception may apply in cases of proven intolerance to visual aids, although this is rare and subject to strict individual assessment. For privately insured patients (PKV), the situation is often much better. Many tariffs of private health insurance provide for partial or even full cost coverage, depending on the individual contract terms. A landmark BGH ruling from 2017 strengthened the rights of PKV policyholders in this respect. You should therefore carefully check the exact costs of private health insurance and its benefits.
Quick Facts: The most important information about cost coverage at a glance
For a quick overview, we have summarised the key facts on reimbursement for laser treatment for hyperopia by health insurers. These points give you an initial assessment of your situation.
Statutory health insurers (GKV) generally do not pay for laser eye surgery for hyperopia, as it is often not classified as medically essential.
Private health insurers (PKV) more often cover the costs, depending on the tariff and contract, up to one hundred percent.
A BGH ruling (IV ZR 533/15) from 2017 significantly strengthens the position of policyholders with private health insurance.
The cost of laser treatment for one eye with hyperopia is often between eight hundred and three thousand euros.
Medical necessity for the GKV only exists in very rare exceptional cases, for example with proven contact lens intolerance and the simultaneous impossibility of wearing other visual aids.
Before the procedure, a cost estimate should always be submitted to the health insurer, especially with private health insurance.
This overview serves as an initial guide, but it does not replace individual advice and a review of your insurance policy.
Practice perspective: requirements and typical costs for farsighted people
In practice, the possibility of laser treatment for long-sightedness depends on several factors. Typically, the refractive error must have been stable for at least one year, and those affected should be at least 18 years old. The cornea must be sufficiently thick, and there must be no other eye conditions that would rule out the procedure. The cost of laser surgery for long-sightedness varies considerably. For Femto-LASIK, a common procedure, you can expect costs from around two thousand two hundred euros per eye when, for example, long-sightedness of up to plus four dioptres is corrected. Many clinics now offer financing options to spread the one-off financial burden. It is advisable to obtain several quotes and to review the terms and conditions for laser eye surgery under private health insurance carefully. A glasses insurance or vision aids insurance can, under certain circumstances, cover the costs of vision aids, but not the laser surgery itself.
Expert-level depth: Legal foundations and medical necessity
From a legal perspective, cost coverage for laser treatment for farsightedness by health insurance is clearly regulated, although it differs between statutory and private health insurance. Statutory health insurance is bound by the principle of cost-effectiveness and regards glasses or contact lenses as sufficient care as long as there are no serious medical reasons against them. The medical aids guidelines of the Joint Federal Committee (G-BA) define when visual aids can be prescribed at the expense of statutory health insurance. For a laser operation to be covered by statutory health insurance, a very high level of medical necessity would have to be proven, going beyond the mere correction of the refractive error. This is extremely rarely the case for farsightedness. For privately insured patients, the aforementioned BGH ruling of 29 March 2017 (case no. IV ZR 533/15) provided an important clarification. According to this, a refractive error is considered an illness and laser surgery a medical treatment. Insurers may then not simply refer to cheaper aids if a recognised treatment method exists. Our expert tip: Always submit a detailed cost estimate to your private health insurer and, where appropriate, an ophthalmological report substantiating the necessity and appropriateness of the procedure. The regulations for glasses under statutory insurance are not transferable here.
Strategies for cost coverage: Your roadmap to success
To increase your chances of having the cost of laser treatment for your long-sightedness covered by your health insurance, a structured approach is essential. Here are some steps to follow:
Check your insurance policy carefully, especially the benefits for visual aids and refractive surgery. This applies particularly to those with private insurance.
Obtain a detailed cost estimate from the eye clinic. It should list the diagnosis, the planned method and the exact costs per eye.
Submit the cost estimate together with a formal application for cost coverage to your health insurer – for private health insurance, this is standard; for statutory health insurance, it is at least worth trying in order to obtain a binding rejection.
Ask your ophthalmologist to certify the medical necessity, if there are grounds for doing so (e.g. high dioptre values, intolerance of contact lenses combined with a desire to be independent of glasses).
If your private insurer rejects the claim: review the reasoning and, if necessary, cite the 2017 Federal Court of Justice ruling. An appeal can definitely be successful here.
Find out whether you can claim the costs for tax purposes as exceptional expenses if the health insurer does not pay.
Careful preparation and communication with your insurer can make all the difference. Regular eye-doctor check-ups covered by the health insurer are certainly important, but they usually do not directly influence the decision on whether laser eye surgery costs are covered.
Take alternative financing and tax aspects into account
If your health insurer does not cover the cost of laser treatment for your long-sightedness, or only covers part of it, there are other considerations. Many eye clinics offer instalment plans or financing options, often even interest-free for a certain period, for example for 24 months. This can significantly reduce the financial barrier. Another important option is tax deductibility. Under certain conditions, the costs of eye laser surgery can be claimed as extraordinary expenses in your income tax return. As a rule, the requirement is that the procedure was medically indicated, which is often the case with a visual impairment such as long-sightedness. Please keep all invoices and receipts carefully. It is advisable to discuss this with a tax adviser in order to make use of the optimal deduction options for your individual situation. In this way, financial relief can be achieved even without direct cost coverage from the health insurer.
The question of whether laser treatment for long-sightedness is covered by health insurance shows how important it is to choose the right insurance. At nextsure, we understand that in healthcare in particular, individual needs and tailor-made solutions matter. Although we do not directly cover the costs of laser eye surgery, we offer comprehensive advice on private health insurance and supplementary health insurance policies that can provide you with valuable support in many healthcare matters. For example, a strong private health insurance policy can cover the costs of laser eye treatment, depending on the tariff. Let us review together how your insurance cover can be optimised so that you are as well prepared as possible for future healthcare expenses too. We help you keep track in the complex insurance market. The right cover gives you peace of mind, not just when it comes to questions about vision.
Request an individual risk analysis now: Have your insurance situation reviewed free of charge and receive specific optimisation suggestions.
More useful links
Wikipedia offers comprehensive information on hyperopia (long-sightedness).
Wikipedia explains the phenomenon of presbyopia (age-related long-sightedness).
The DOG and the BVA provide a joint statement on the assessment and quality assurance of refractive surgical procedures.
The Professional Association of German Ophthalmologists (BVA) offers a PDF document on quality assurance in refractive surgery.
The German Medical Journal provides basic knowledge on refractive surgery.
The German Ophthalmological Society (DOG) provides statements and recommendations for doctors.
The German Society for Intraocular Lens Implantation and Refractive Surgery (DGII) offers a PDF with basic knowledge on refractive surgery.
augeninfo.de, an information site of the Professional Association of German Ophthalmologists, provides information on refractive surgery and seeing without glasses.
The Joint Federal Committee (G-BA) publishes press releases on important decisions and regulations in healthcare.
The Stiftung Warentest offers advice and a test report on laser eye surgery.
FAQ
Does my statutory health insurance cover the cost of laser treatment for my farsightedness?
Unfortunately, in most cases not. Statutory health insurance providers often classify laser eye surgery for hyperopia as a cosmetic procedure or a discretionary benefit, as long as correction with glasses or contact lenses is possible. Costs are only covered in very rare, medically essential exceptional cases.
What are the chances of my private health insurance (PKV) covering the costs?
The chances are significantly better with private health insurance. Many plans cover the cost of laser eye surgery for long-sightedness, in full or in part. A Federal Court of Justice ruling from 2017 strengthened policyholders' position. It is crucial to check your plan and submit a cost estimate in advance.
How much does laser treatment for long-sightedness cost approximately?
Prices vary significantly depending on the clinic, the method used (e.g. Femto-LASIK) and the dioptre value. Expect costs between eight hundred and three thousand euros per eye. You can obtain exact prices through an individual quotation.
Is there an age limit for laser treatment of long-sightedness?
Yes, as a rule, patients must be at least 18 years old. However, more important than age is stable vision for a period of at least one year before the procedure.
What can I do if my health insurer refuses to cover the costs?
Where the statutory health insurance (GKV) rejects it, the options are limited unless there is a rare medical exceptional case. If the private health insurance (PKV) rejects it, you should check the reasoning and, if appropriate, lodge an objection citing the 2017 Federal Court of Justice ruling. Alternatively, you can claim the costs for tax purposes as extraordinary expenses.
What role does the dioptre value play in cost coverage?
The dioptre value itself is usually not the sole criterion for reimbursement by statutory health insurance (GKV). In the case of private health insurance (PKV), the level of the dioptres may, in individual cases, support the medical argumentation, but since the Federal Court of Justice ruling it is no longer the only decisive criterion for the fundamental obligation to provide benefits in the event of medical necessity. However, the costs of the procedure may depend on the dioptre value.
