Cost units

If an assistive product is used privately, the costs are often covered by the statutory health insurance companies. The entitlement and conditions for this are regulated by law.

In addition to the statutory health insurance (GKV), other cost bearers may also be responsible. The question as to which insurance provider is responsible depends on various factors.

The legal basis for the financing of asistive products by the statutory health insurance fund is § 33 SGB V.

Accordingly, insured persons are "entitled to the provision of hearing aids, body prostheses, orthopaedic and other assistive products which are necessary in individual cases:

  • to ensure the success of the medical treatment,
  • to prevent an imminent disability or
  • to compensate for a disability

insofar as the assistive products are not to be regarded as general articles of daily use or are excluded under § 34 Para. 4".

The entitlement also includes the supply of the necessary assistive products:

  • the necessary modification, repair and replacement of assistive products,
  • the training in their use,
  • the necessary maintenance and technical checks.

The statutory nursing insurance can be responsible for measures to improve the living environment (§ 40 Para. 4 SGB XI). The prerequisite is the existence of a degree of care. This financial support usually includes a grant of up to 4,000 euros per measure. The subsidy is independent of income. If several people in need of care live together, a subsidy of up to 16,000 euros can be applied for. However, a measure is only subsidised once, even if it benefits several people in need of care and the construction measures are at different times. The subsidy can be applied for again if an illness or disability worsens.

In addition, costs for nursing aids are covered by the nursing insurance if there is no obligation to pay benefits from the health insurance. In this case, a co-payment (the nursing care insured's own contribution) must be made. Larger technical nursing aids are often loaned out, so that a copayment is not required.

Costs for consumer products are reimbursed by the nursing care insurance by up to 40 euros per month.

For privately insured persons, the regulations of the Social Security Code for the financing of aids do not apply. Rather, the general insurance conditions and possible individual additional agreements are decisive here.

In the case of private health insurance companies, the provision of aids depends on the individually concluded contract and the respective scope of the tariff.

For this reason, no generally valid statement can be made here about the financing of medical aids. It is important to obtain detailed advice before concluding a contract as to whether and to what extent the costs for aids are covered by the insurance.

They may also be eligible as cost bearers for the supply of assistive devices for private use:

  • accident insurance (SGB VII): for accidents at work and occupational diseases
  • Social assistance (SGB XII): mainly for benefits for participation in community life, usually dependent on income and assets (subordinate)