Savings tip: When the health insurance company subsidizes glasses

Costs for glasses vary depending on individual needs

According to a YouGov study from 2022, 74 percent of all Germans wear glasses permanently or at least occasionally to improve their eyesight. If you only need glasses for reading or driving, you don’t need to attach too much importance to value or brand. On the other hand, people who rely on visual aids in everyday life and at work due to severe visual impairment should not save money here, according to the information guide Krankenkasseninfo.de. In any case, good lenses as well as a frame that fits as accurately as possible, is stable and yet easy to wear is crucial for wearing comfort. The costs as well as the qualities vary greatly. According to Krankenkasseninfo.de, it is possible to get a complete pair of progressive lenses including lenses for less than 150 euros, but good lenses with anti-reflective coating cost around 400 euros – each.

Entitlement to health insurance subsidies is regulated by law

As part of the health care reform in 2004, the federal government removed the cost coverage for glasses and lenses from the health insurance companies’ catalog of benefits. Since 2017, people with severe visual impairment have again been subsidized by statutory health insurance. According to Section 33 of the Social Code V (for nearsightedness or farsightedness), the limit value is a visual impairment of six diopters in at least one eye. If you have astigmatism, four diopters are enough for prescription glasses. People whose maximum vision – with glasses and contact lenses – is less than 30 percent are also supported. A new subsidy from the health insurance company is only available if your vision has deteriorated by at least 0.5 diopters.

According to opticians’ associations, around 1.4 million people are affected by such severely impaired vision and can claim a subsidy, Health Insurance Info.de announces – however, statutory health insurance only covers the costs for simple standard lenses. You usually have to pay extra for the glasses frame and extras such as plastic lenses, progressive lenses or anti-reflective lenses. Only if higher quality glasses are medically necessary and a doctor’s prescription is available will these also be covered by the health insurance company. According to the umbrella association of statutory health insurance (GKV), the fixed amounts range from ten to a maximum of 190 euros per jar. How much the health insurance company ultimately pays for the glasses depends on various factors. This includes the type of ametropia, the diopter number and the material and design of the lenses. A current list of the applicable fixed amounts for glasses and other visual aids is published on the website of the National Association of Statutory Health Insurance Funds.

Anyone who is over 18 years old and whose eye test confirms that they have only mild or moderate visual impairment is still not legally entitled to a subsidy for glasses and visual aids from their health insurance company. If there is a doctor’s prescription, some statutory health insurance companies grant their insured persons a subsidy as a voluntary statutory benefit.

Costs for contact lenses are rarely covered

The legislature generally assumes that glasses are provided. According to a report from the consumer advice center, a subsidy for contact lenses is usually only approved if they are medically necessary. This is the case, for example, with nearsighted or farsighted people with more than eight diopters, as the corresponding lenses would be too heavy. In addition, the cost of contact lenses will be covered by your health insurance if they provide at least 20 percent better results than glasses for astigmatism.
If the requirements for reimbursement for spectacle lenses are only met, this can also be applied to contact lenses as visual aids. The health insurance companies then always cover the costs up to the amount of purchasing comparable lenses. In any case, the costs for the necessary hygienic and medical accessories must be borne by yourself.

Children with poor eyesight usually receive a subsidy

According to Krankenkasseninfo.de, the statutory health insurance company will always cover glasses for children up to 14 if the doctor’s prescription shows that there is otherwise a risk of deterioration in vision as they get older – which is almost always the case with children with visual defects. In order for the costs to be covered for young people between the ages of 14 and 18, there must be a prescription for medical reasons.

Private health insurance companies more often pay for glasses

According to the guide DeutscheOptiker.de, private health insurance companies more often offer tariffs that also include visual aids such as glasses and contact lenses. The conditions as well as the type and amount of the subsidies can vary greatly depending on the health insurance company and tariff.

Editorial team finanzen.net