Laser treatment for short-sightedness: Health insurance does not cover the costs.

Laser eye surgery offers an effective way to permanently correct vision problems such as short-sightedness and eliminate the need for glasses or contact lenses. However, statutory health insurers usually do not cover the cost of this treatment.

This is because nearsightedness is generally regarded as a non-serious medical impairment and can be adequately corrected with corrective eyewear. On our blog, we explain the precise reasons for this decision and the alternatives available.

In the following sections, we provide a comprehensive overview of the various laser procedures available for treating short-sightedness and explain the role of individual diopter values and medical necessity in the assumption of costs by the health insurance companies.

Statutory and private health insurance in Germany

Differences between statutory and private health insurance

In Germany, insurance is compulsory for all citizens. Health insurance can be obtained either through statutory health insurance (GKV) or private health insurance (PKV).

Statutory health insurance (GKV) is compulsory for all employees whose regular annual gross income falls below the annual earnings threshold. The benefits of the GKV are defined by law and include a wide range of medical treatments and medications.

Private health insurance, on the other hand, is primarily intended for the self-employed, freelancers, and employees with high incomes. The benefits offered by the PKV can be tailored individually and are generally more comprehensive than those of the GKV.

Laser treatment for short-sightedness and coverage by health insurance companies

In the field of laser eye treatments, there are often differences between private (PKV) and statutory (GKV) health insurance. Since this type of treatment is frequently classified as “not medically necessary” because alternative visual aids such as glasses or contact lenses are available, statutory health insurers usually do not cover the costs.

It is often different with private health insurers. Depending on the specific tariff and the individual agreements in the insurance contract, the PKV may at least partially cover the costs of an eye laser treatment.

It is important to note that this is not a general rule and that specific cost coverage should always be clarified with the relevant health insurance company on a case-by-case basis. Whether you have statutory or private health insurance, it is advisable to obtain a cost estimate before undergoing laser eye surgery and to discuss it with your health insurance company. This will ensure you are informed in advance about potential costs and help you avoid unexpected surprises.

When is laser treatment for short-sightedness covered by health insurance?

In addition to the general assessment of medical necessity, individual factors also influence whether the costs of laser eye treatment are covered. In particular, the diopter values for myopia and specific circumstances—such as pressure marks on the nose, dizziness, or an intolerance to contact lenses—are relevant.

Diopter values in short-sightedness and cost coverage

The diopter values are a measure of the severity of a refractive error. The higher the diopter value, the more severe the refractive error and the greater the need for correction. Some health insurers use these values when assessing whether to cover the costs.

For example, new cost coverage may only be considered if the refractive error exceeds a certain diopter value. As a rule, the more severe the refractive error, the more likely that a medical need for laser eye treatment will be recognised.

What is short-sightedness?

Nearsightedness, also known as myopia, is a common refractive error in which distant objects appear blurred while nearby objects can be seen clearly.

Short-sightedness occurs when the eye is too long relative to its refractive power. As a result, the light rays entering the eye converge in front of the retina rather than directly on it, producing a blurred image. Typically, this refractive error is corrected with visual aids such as glasses or contact lenses that have a negative diopter value.

How does laser eye treatment work for nearsightedness?

Laser eye treatment is a modern method used to permanently correct refractive errors. In this treatment, a laser reshapes the cornea so that light is focused correctly on the retina. There are various laser eye procedures, including LASIK, Femto-LASIK, LASEK, PRK, and ReLEx SMILE.

In the LASIK procedure, a thin corneal flap is created with a microkeratome or femtosecond laser and folded to the side. The underlying corneal tissue is then ablated with an excimer laser to reshape it. The flap is folded back into place and acts as a natural bandage.

Femto-LASIK is a further development of LASIK in which both steps of the procedure are performed with a laser. This approach increases the precision and safety of the procedure.

In the LASEK and PRK procedures, the outermost layer of the cornea (the epithelium) is removed or moved aside before the underlying corneal tissue is treated with the laser.

ReLEx SMILE is one of the newest methods of laser eye treatment. A small disc of tissue is separated from within the cornea and extracted through a tiny incision. The procedure is particularly gentle, and more of the cornea’s stable tissue is preserved.

All of these procedures aim to reshape the cornea so that light is once again correctly focused on the retina, thereby improving visual acuity. Which procedure is most suitable for each patient depends on several factors, including corneal thickness, the degree of refractive error, and the overall health of the eye.

What you should do next

Now that you have a comprehensive overview of the various aspects of laser treatment for short-sightedness and the role of health insurers in covering costs, the question naturally arises: What happens next?

The first step should always be a thorough consultation. For example, you can book an appointment with Doctor-medic Bányai, who can provide detailed information about the various treatment options and answer any questions you may have about the procedure.

During this consultation, a free preliminary examination is usually carried out to assess your individual health and your suitability for laser eye treatment. Various aspects are examined, such as corneal thickness, your diopter values, and any existing eye conditions. You are welcome to take our laser eye aptitude test online!

In addition, you should obtain a cost estimate. This will give you an overview of the expected costs of the procedure and allow you to discuss them with your health insurance provider in advance and clarify any questions about coverage. At Augenheilkunde Bányai, you can also benefit from an interest-free installment plan.

Finally, we would like to reassure you that, despite the wealth of information and considerations that laser eye treatment involves, the most important consideration should always be your health and well-being. Take the time you need, gather detailed information, and make your decision only when you feel confident and well advised.

We wish you all the best on your way to a life without glasses or contact lenses!

FAQs – Laser treatment for short-sightedness – When does health insurance pay?