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How to apply for aids and care aids

There are many nursing aids and aids. From bed protection inserts and disinfectants to bath and shower aids to walking aids and care beds, everything is possible. At least in theory. Because everyday helpers have their price. Many affected people therefore limit themselves to the bare minimum - and often pay for it out of their own pocket. There are several cost bearers who pay for (nursing) aids if there is a medical need.

Who will pay the costs?

Care aids are and must be paid for by the long-term care insurance

  • facilitate maintenance or
  • alleviate the patient's discomfort or
  • enable a more independent lifestyle

Note: People with a care level receive monthly care aids from the care insurance fund to the value of 60 euros. You can read more about this in our article One less worry: Have free care aids delivered

Aids are and must be paid for by the health insurance company

  • ensure successful medical treatment or
  • prevent a disability or
  • serve to compensate for an existing disability

Other possible contact points:

Depending on the individual case, it may happen that the costs for (nursing) aids are not covered by the health or nursing care insurance, but by one of the following cost units. So it can be worthwhile to ask here as well and to find out about the various options:

  • statutory accident insurance in the event of illness or disability after an accident at work
  • private accident insurance in the event of illness or disability after an accident in your free time
  • Employment Agency for aids that are necessary for the job
  • Pension insurance for aids that are necessary for the job
  • Social welfare office if there is a right to care assistance
  • Youth Welfare Office in children and adolescents

How do I submit an application?

In order to apply for the cost of (care) aids to be reimbursed, those affected should contact one of the above-mentioned insurance providers, depending on their individual situation. The health insurance company is usually the first point of contact.

For the application, those affected need a prescription from their doctor. The ordinance must show that a certain aid is medically necessary.

By the way: Care aids for consumption (e.g. bed protection inserts, disinfectants, disposable gloves, face masks) are financed by the care fund. People with care grade can receive care aids worth 60 euros per month. Providers of so-called care boxes usually also help with the application.

Health insurance must meet deadlines

Insured persons submit the medical prescription to their health insurance company for approval. The health insurance fund can accept or reject the application - but according to the consumer advice center, it only has three weeks to make a decision. If an opinion from the medical service of the health insurance company (MDK) is required, the deadline is extended to five weeks. If the health insurance company does not manage to meet the three or five week deadline, it must inform the applicant in good time, with a written justification. If it does not do this, the application is deemed to have been approved. Applicants can then obtain the aid themselves and bill the health insurance company. She is legally obliged to pay for it.

Also read: Processing times: How fast do health and long-term care insurance funds have to be?

Be sure to choose the right supplier

If the application for assumption of costs has been approved, the aid can be obtained. But be careful: health insurances only pay if the insured purchase the aid from an approved supplier. These can be pharmacies or medical supply stores, for example. If you want to get an aid, you should definitely get a list of possible suppliers / sellers from the health insurance company. Otherwise there is a risk that the costs will not be covered.

How high is the co-payment?

If the assumption of costs has been approved by the health insurance company, the long-term care insurance company or another cost unit (see above), those affected usually only have to pay a small amount themselves. For most drugs and aids, this is 10 percent, but at least 5 euros and a maximum of 10 euros. No co-payment has to be made for care aids for consumption (e.g. care boxes).

Anyone who has exceeded the annual limit of 1 or 2 percent of gross income can be exempted from the additional payment. Read more about this here: How to get exempt from co-payment for medication

Running costs also have to be covered

There are aids that are not only expensive to purchase, but also cause running costs. This includes repairs, maintenance, accessories, spare parts and electricity costs. If the assumption of costs for an aid has been approved, the cost unit must also pay for this.

Also read: When the health insurance company has to reimburse electricity costs

But be careful: Clarify the claim for reimbursement of costs before any repair, maintenance or adjustment of the aid with the cost bearer. It can happen, for example, that the health insurance company only pays for a repair if it is necessary according to the treating doctor.

What aids are there?

All aids and care aids are listed in the medical aids directory of the health insurance companies. They are divided into the following product groups:

1. Extractors
2. Adaptation aids
3. Application aids
4. Bath and shower aids
5. Bandages
6. Irradiation equipment
7. Aids for the blind
8. Deposits
9. Electrical stimulation devices
10. Walking aids
11. Aids against pressure ulcers
12. Aids in tracheostomy and laryngectomy
13. Hearing aids
14. Inhalation and respiratory therapy devices
15. Incontinence aids
16. Communication aids
17. Aids for compression therapy
18. Ambulance / Disabled Vehicles
19. Nursing items
20. Positioning aids
21. Measuring devices for body conditions / functions
22. Mobility aids
23. Orthoses / splints
24. Prosthetic legs
25. Visual aids
26. Sitting aids
27. Speech aids
28. Standing aids
29. Ostomy articles

31. Shoes
32. Therapeutic exercise devices
33. Toilet aids
34. Hair replacement
35. Epitheses
36. Prosthetic eyes
37. Breast prostheses
38. Prosthetic arms

50. Nursing aids to facilitate care
51. Care aids for personal hygiene / hygiene and to alleviate complaints
52. Nursing aids for more independent living / mobility
53. Nursing aids to relieve discomfort
54. Care aids intended for consumption

98. Other care aids
99. Miscellaneous

You can find out which individual aids belong to the product groups in the list of aids provided by the National Association of Statutory Health Insurance Funds.