Aids - Who bears which costs?

 Health insurance companies do not always fully cover the costs of an aid. Find out here what the cost components are and what you have to pay for yourself.

The essentials in brief:

• There are different cost components: Co-payment, additional costs, surcharge and personal contribution.
• Co-payments must also be made for aids.
• Insured persons are always entitled to an aid that is financed by the health insurance company without an additional payment.

There are many different costs in connection with aids and aids for consumption: co-payment, additional costs, surcharge, personal contribution.

Aids include a large number of products such as

• Incontinence help
• compression stockings,
• shoe inserts,
• prostheses,
• wheelchairs or
• hearing aids.

The health insurance company is entitled to be supplied with the aid as a benefit in kind. This means that the health insurance company provides the insured person with the aid and commissions a service provider (e.g. a medical supply store) to do so. If it comes to the supply of the aid, you often have to contribute to the costs in several positions: 

Statutory co-payments for aids

As with the supply of medicines or hospital stays, there is also a statutory co-payment obligation for the insured person for the supply of medical aids.

The co-payment rule of 10 percent applies to aids - but at least 5 euros and a maximum of 10 euros. You pay this amount to the aid provider. Children up to the age of 18 are exempt from co-payments.

For aids that are intended for consumption and are therefore always needed again (e.g. insulin syringes), you pay an additional 10 percent of the costs per pack - but a maximum of 10 euros for the entire monthly requirement for such aids. 

Additional costs or surcharges for aids

After an application for an aid has been approved by the health insurance company, insured persons receive medically sufficient aids from the medical supply stores, opticians and orthopedic technicians who have concluded contracts with the health insurance company. 

The aids are mostly standard versions for which no additional personal work has to be paid. As a rule, these models ("POS devices") are sufficient to cover the medically required needs. 

Since the amendments to the Medicines and Aids Supply Act, service providers have been obliged to advise insured persons on the correct supply of aids in individual cases. This also includes advice on additional free aids. The service provider must have this confirmed with a signature of the insured person in a consultation protocol. As a rule, however, you will also be shown other, more expensive aids. 

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Tip:

You are always entitled to an offer that is fully funded by the health insurance company. So ask if the medical supply store does not offer you such an aid. You can also inquire about the benefits of the other tools for you personally. 

After an extensive consultation, you can also decide on an aid that goes beyond what is necessary. This can be, for example, a higher quality version or special functions. These additional costs are not fully covered by health insurance.

Sometimes the additional costs are also referred to as “surcharges”. In a written declaration of additional costs, you confirm that you have been informed about the personal contribution and that you are not submitting a reimbursement application to the health insurance company for this amount. 

As long as the aid corresponds to a regular health insurance benefit, no additional payment may be taken. 

Additional costs for medically necessary aids 

If a higher-quality aid is medically necessary in an individual case, the health insurance company is obliged to cover the corresponding higher costs upon request. This is the case, for example, in the case of significant necessary functional advantages. However, if you want a different aid for optical reasons (e.g. a nicer or more colorful hearing aid), or the aid has advantages that are not covered by health insurance (e.g. does not cover a basic need), you will have to bear the additional costs yourself. 

When this is the case depends on the individual case. Courts also make very different decisions here. 

Your personal contribution to aids

In the case of items that every person needs in everyday life and that also serve to compensate for a disability or to ensure treatment, a personal contribution is taken into account. The amount is based on the costs for a commodity without therapeutic use. This is the case, for example, with orthopedic shoes, where you would have to pay the cost of normal street shoes as your own contribution. 

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