Vision & Eye Care

Eye Exams at the Augenarzt

The good news first: visiting an Augenarzt (ophthalmologist) is fully covered by GKV. You can get a referral from your Hausarzt or go directly — eye doctors are one of the specialties where direct access is standard. The Augenarzt checks your eye health, screens for diseases, measures eye pressure, and examines the retina.

However, there's a key distinction: the medical eye exam at the Augenarzt is covered, but a Brillenbestimmung (refraction test to determine your exact prescription for glasses) done at an optician (Optiker) is not covered by GKV. If your Augenarzt does the refraction as part of a medical examination, it's covered. If you walk into Fielmann or Apollo and ask them to measure your eyes for new glasses, that's on you — typically €10-25.

The Strict GKV Rule for Glasses & Contacts

Here's where it gets frustrating. Since 2004, GKV has dramatically cut back vision coverage for adults. The rule is simple and strict:

GKV only pays for glasses or contact lenses if:

• You are under 18 years old
• You are an adult with severe visual impairment — meaning your prescription is over ±6 diopters (sphere), or you have more than 4 diopters of astigmatism, or your visual acuity is 30% or less (0.3 or worse) even with the best possible correction

That's it. If you're a 35-year-old with -3.0 diopters — which is quite nearsighted and you genuinely cannot function without glasses — GKV pays nothing toward your glasses. You're entirely on your own. This affects the vast majority of glasses wearers in Germany, since most prescriptions fall between -6 and +6 diopters.

What GKV Actually Pays When You Qualify

If you do meet the strict criteria (under 18, or severely impaired), GKV covers glasses and contacts through the Festbetrag system — a fixed allowance for basic lenses:

• Basic single-vision lenses: GKV pays around €10-112 per lens depending on your prescription strength and whether you need special features
• Progressive lenses (Gleitsichtgläser): GKV pays a Festbetrag for multifocal lenses, but the amount is modest — typically €25-130 per lens
• Frames: GKV does not pay for frames at all. You choose and pay for frames yourself.
• Lens upgrades: Anti-reflective coating, thinner lenses (higher index), photochromic lenses — all upgrades are out of pocket
• Replacement: You can get new lenses when your prescription changes by at least 0.5 diopters

In practice, even when GKV covers lenses, you'll still pay a significant portion out of pocket for anything beyond the most basic options. The Festbetrag covers functional but bare-minimum lenses.

Children's Vision Coverage

Children get much better vision coverage than adults:

• Under 14: Full coverage for glasses lenses with any prescription. GKV pays the Festbetrag for lenses, and new glasses can be prescribed whenever the prescription changes.
• Ages 14-17: Same coverage, but a new prescription from an Augenarzt or Optiker is required to get new lenses covered.
• Frames: Even for children, GKV does not cover frames. However, many opticians offer free or very cheap children's frames as part of package deals.
• Vision screening: Regular eye exams are part of the U-Untersuchungen (pediatric checkups) and fully covered.

Contact Lenses

Contact lenses are covered by GKV only in very specific medical situations — not just because you prefer contacts over glasses. GKV covers contacts when:

• Keratoconus: Cone-shaped cornea that can't be corrected adequately with glasses
• Extreme ametropia: Very high prescriptions where glasses would be impractically thick or cause severe distortion
• Anisometropia over 2 diopters: Significant difference in prescription between the two eyes (more than 2 diopters)
• Irregular astigmatism: When the cornea is irregularly shaped (e.g., after injury or surgery) and can't be corrected with regular glasses
• After cataract surgery: In some cases where intraocular lenses aren't suitable

For everyone else — and that's the vast majority of contact lens wearers — it's 100% out of pocket. Monthly contact lenses typically cost €15-40/month, plus solution and care products. Daily disposables run €30-60/month. An annual contact lens subscription is €200-500/year.

Laser Eye Surgery (LASIK, SMILE, PRK)

Laser eye surgery is increasingly popular in Germany, but the insurance situation is clear-cut:

GKV: Not Covered

GKV does not cover laser eye surgery. Period. LASIK, SMILE Pro, PRK, LASEK — none of these procedures are covered by public health insurance. GKV considers them cosmetic/elective because glasses or contacts are a viable alternative.

PKV: Sometimes Covered

Some private insurance tariffs do cover laser eye surgery, but it depends entirely on your specific contract. More on this in the PKV section below.

What It Costs

Eye Disease Treatment — Fully Covered

Here's where GKV shines. All medically necessary treatment for eye diseases is fully covered, including:

• Glaucoma (Grüner Star): Eye pressure measurement, medication (eye drops), laser treatment (SLT, ALT), and surgery — all covered when diagnosed
• Cataract surgery (Grauer Star): One of the most common surgeries in Germany. The standard procedure with a basic intraocular lens is fully covered. Premium lenses (multifocal, toric) cost extra — €500-2,000 per eye out of pocket for the upgrade
• Macular degeneration (AMD): Intravitreal injections (anti-VEGF treatment like Lucentis or Eylea), regular monitoring, and OCT scans when medically indicated — all covered
• Diabetic retinopathy: Screening, laser treatment, intravitreal injections, and surgery — fully covered as part of diabetes management
• Retinal detachment: Emergency surgery fully covered
• Strabismus (Schielen): Treatment including surgery, especially in children — fully covered
• Keratoconus: Crosslinking treatment, specialty contact lenses — covered

The key distinction is that GKV covers disease treatment comprehensively but considers vision correction (glasses, contacts) a personal expense for most adults.

IGeL Services at the Augenarzt

Eye doctors are among the top providers of IGeL (Individuelle Gesundheitsleistungen) — self-pay services that your doctor may recommend but GKV doesn't cover:

• Glaucoma screening (Glaukom-Vorsorge): €20-40. Measures eye pressure and examines the optic nerve. GKV only covers this when there's a medical indication (symptoms, family history, elevated pressure). As a pure screening without symptoms, it's IGeL. The IGeL-Monitor rates this as "tendenziell negativ" (tending negative) for low-risk patients.
• OCT scan (Optische Kohärenztomographie): €80-150. Detailed 3D imaging of the retina. Covered by GKV for diagnosed conditions (AMD, glaucoma), but not as a preventive screening.
• Visual field test (Gesichtsfeldmessung): €20-40. Covered when medically indicated, IGeL when done for screening purposes without symptoms.
• Macula check for AMD prevention: €30-60. Screening for age-related macular degeneration in patients without symptoms.

Vision Coverage in PKV (Private Insurance)

Private insurance generally offers much better vision coverage than GKV, but it varies significantly by tariff:

• Glasses and contacts: Most PKV tariffs include an allowance of €200-500 every 2-3 years for glasses or contact lenses. Some premium tariffs offer more. This covers frames, lenses, and contacts — your choice.
• No diopter threshold: Unlike GKV, PKV pays regardless of your prescription strength. Even with -1.0 diopters, you get the allowance.
• LASIK / laser surgery: Some tariffs cover laser eye surgery partially or fully. Typical coverage ranges from €1,000-3,000 per eye, sometimes with a lifetime cap. Check your specific Tarifbedingungen (policy terms).
• Refraction: Eye tests at opticians are typically covered as part of the vision benefit.
• Premium lenses for cataract surgery: Some PKV tariffs cover multifocal or toric intraocular lenses that GKV doesn't.

If vision coverage is important to you and you're considering PKV, check the Sehhilfen (vision aids) section of the tariff carefully. The difference between a basic and premium PKV tariff can be significant for vision benefits.

Brillenzusatzversicherung (Supplementary Vision Insurance)

Since GKV pays nothing for most adults' glasses, there's a market forsupplementary vision insurance. But is it worth it?

What it typically offers:

• Allowance: €100-300 every 2 years for glasses or contacts
• Premiums: €5-15/month (€60-180/year)
• Waiting period: Usually 3-6 months before first claim
• Some plans include: LASIK subsidies (€500-1,000), sunglasses with prescription, workplace glasses

The math usually doesn't work out:

Let's say you pay €10/month (€120/year) for a plan that covers €200 every 2 years. You pay €240 in premiums over 2 years to get €200 back. You're losing money. Even with a generous plan, the break-even point is tight.

Practical Tips for Saving on Vision Care

1. Buy glasses online: Retailers like Mister Spex, Fielmann online, Brille24, and Zenni Optical offer significantly lower prices than brick-and-mortar shops. You can save 30-60% on the same quality lenses.
2. Get your prescription at the Augenarzt: It's covered by GKV (as part of a medical exam), then take the prescription to a cheaper online retailer. You have the right to receive your prescription in writing (Brillenpass).
3. Fielmann's Nulltarif: Fielmann offers basic complete glasses (frame + single-vision lenses) starting from €0 with just the GKV voucher for those who qualify, or very cheap packages for everyone else. Not the trendiest frames, but functional.
4. Tax deduction as Arbeitsmittel: If you need glasses primarily for work (especially computer glasses / Bildschirmarbeitsplatzbrille), your employer may be required to pay for them under workplace safety regulations. Ask your Betriebsarzt.
5. Tax deduction as außergewöhnliche Belastung: You can list glasses costs on your tax return. You'll need a prescription (Verordnung). Whether it helps depends on your total medical expenses exceeding the zumutbare Belastung threshold.
6. Workplace glasses (Bildschirmbrille): If you work at a computer and need special glasses for screen distance, your employer must pay for a basic pair. This is required under the Bildschirmarbeitsverordnung — ask your HR department.
7. Compare LASIK providers: Prices vary widely between clinics. Get quotes from at least 3 providers. Chains like EuroEyes, Smile Eyes, and Care Vision often offer promotions. Don't choose purely on price — check the surgeon's experience and the clinic's track record.
8. Contact lens subscriptions: Services like Mister Spex, Lensbest, or directly from manufacturers often cost less than buying from your Optiker. Factor in the annual fitting fee if you go this route.