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Emergency

Medical aids: avoiding extra costs and co-payments

Medical aids such as hearing aids, rollators, or insoles are paid for by the health insurer if they are medically necessary. Often, however, extra costs are demanded for 'better' models. Yet an adequate, surcharge-free supply must always be offered.

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Your chances of getting your money back

Insured persons are entitled to an adequate, appropriate supply of medical aids (§ 33 SGB V). The fund must offer a surcharge-free model that covers the medical need; besides that, only the statutory co-payment applies.
Extra costs for more comfortable or better-looking variants are voluntary. If an expensive surcharge is presented to you as the only option, be careful: demand the surcharge-free comparison model.

What you should do now

  1. 1

    1. Check the prescription

    Have the aid medically prescribed and clarify the need.

  2. 2

    2. Demand a comparison model

    Insist on a surcharge-free, medically adequate model.

  3. 3

    3. Question extra costs

    Have it explained which surcharge applies for which additional function.

  4. 4

    4. Act on refusal

    If the necessary supply is refused, file an objection.

How to spot the scam

  • No surcharge-free model is offered.
  • An expensive surcharge is presented as the only option.
  • The statutory co-payment and voluntary extra costs are mixed together.

Frequently asked questions

Do I have to pay extra for a medical aid?

For an adequate, appropriate supply, only the statutory co-payment. The fund must offer a surcharge-free model that covers the medical need (§ 33 SGB V). Extra costs only arise if you voluntarily choose a more expensive model.

What is an 'economic surcharge'?

If you choose a medical aid with features beyond what is medically necessary, you bear the difference yourself as a surcharge. It is voluntary. What matters is that you were first offered an alternative fully covered by the fund.

What can I do about unnecessary extra costs?

Expressly demand the surcharge-free comparison model and have any additional costs justified. If an adequate supply is refused or offered only for a surcharge, you can turn to your fund and file an objection against a refusal.

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.