High expenses for medication can be stressful, exemption from co-payment can relieve pensioners financially.
You should definitely take note of this.
Hamburg – For many pensioners, co-payments for medication have become a financial burden.
There is a statutory co-payment of five to a maximum of ten euros for each drug on a health insurance prescription.
For people who depend on multiple medications, costs can quickly escalate.
If there are also deductibles for hospital stays or rehabilitation, the co-payments for pensioners quickly become unaffordable.
However, you can be exempted from these costs.
In principle, anyone over the age of 18 with statutory health insurance can submit an application to the health insurance company.
Whether they are also exempt depends on various factors: First, the individual load limit is calculated on the basis of the total annual gross income.
It marks the amount of expenditure that is reasonable according to the legislator.
Since the load limit depends on income, it varies greatly from person to person.
If the expenses for medication exceed this limit, you can be exempted from co-payment.
However, not all medications count towards the co-payment exemption.
For which medicines can pensioners be exempted from co-payment?
There is a whole list of co-payments that can count towards an exemption.
It is important to note that these are services on a health insurance prescription.
Private prescriptions or self-purchased medicines cannot be considered.
This also applies to medicines or other means for which a surcharge has to be paid.
In particular, travel prophylaxis with drugs against nausea and fever is freely available in pharmacies and therefore does not count towards the exemption.
A list of the pharmacy provides a good overview.
If you are registered as a customer at a pharmacy, you can print out an overview of the medicines you have already purchased.
Here you can usually see exactly which part of the statutory co-payment can be offset.
What is covered by the co-payment exemption?
The statutory additional payment is ten percent of the costs, but at least five euros and a maximum of ten euros.
Co-payments for inpatient treatment such as hospital treatment or rehabilitation are excluded.
Here you pay a flat rate of 10 euros per calendar day.
It is important to keep all invoices and original receipts so that you can present them to the health insurance company.
According to the Association of Substitute Health Insurance Funds (VdEK), the following expenses can be taken into account:
Medicines, bandages and vaccinations
aids
Remedies (e.g. physiotherapy/physiotherapy/massages)
Hospital, rehabilitation and mother/father-child cure
travel expenses
Home care
Home help
All of these services can only be credited if they have been prescribed by a doctor and are fundamentally related to a service that is paid for by the health insurance company.
If, for example, you simply buy a rollator on the Internet without a prescription from the health insurance company and without the approval of the health insurance company, this cannot be taken into account in the expenses either.
According to Techniker Krankenkasse,
costs for dental or IGEL services are also
not included in the exemption.
If you would like to be exempted from additional costs for dentures, you must submit a separate application to the health insurance company.
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The more drugs are needed, the greater the financial burden.
This is how you can get ready for the co-payment
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How is the load limit for an exemption from co-payments calculated?
The load limit is two percent of the total annual gross income.
If there is a chronic illness, the load limit is only one percent of the income.
The chronic illness must be certified by a doctor and attached to the application.
According to the Federal Ministry of Health, the requirements are:
Level three to five
Degree of disability or reduced earning capacity from 60 percent
The presence of a medical condition that requires long-term, continuous treatment and has seen a quarterly doctor's visit for at least one year for the same medical condition
The type of income is also important for the calculation.
According to the consumer advice center, not only the standard old-age pension, but also the disability, company and survivor's pension count towards income.
The amount of the gross pension can be found in the last pension notice.
Pension payments are also taken into account, as well as unemployment and sick pay, capital and interest income, rental income, income from work or income from self-employment.
However, social benefits such as care, child or housing benefits are excluded.
Not only your own income, but also the spouse's income or that of the life partner (in the case of a registered life partnership) is taken into account.
If family insured children live in the household, these must also be taken into account.
If a spouse is insured with another health insurance company, one of the two health insurance companies can be chosen.
The application is then submitted to this as a total budget.
These peculiarities exist for pensioners in care facilities
If you add up the annual gross total income, the amount per family member is reduced by a statutory allowance.
The amount of the exemption can be redefined annually by the legislature.
According to the AOK, the amount in 2023 will be EUR 6,111 for the first relative, i.e. the spouse, and EUR 8,952 for each child who has family insurance or is under the age of 18.
The load limit is not calculated individually for residents with support from the social welfare office, recipients of basic security or citizen's income: there are minimum limits for them.
Like the allowances, these are also redefined annually by the legislature.
In 2023, these limits will be EUR 120.48 and EUR 60.24 for people with a chronic illness.
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Many health insurance companies offer an online calculator that calculates the individual load limit.
If you want to be on the safe side, you can also call your health insurance company to have the limit calculated in advance.
In addition to the co-payment exemption, pensioners can receive additional grants that relieve them financially.
When can I apply for exemption from co-payment for medication?
The exemption is only valid for one calendar year.
This also means that an application must be submitted every year.
According to the VdEK, you can submit the application to the health insurance company at different times: If the calendar year is complete, you can submit the application retrospectively.
The health insurance company then calculates the amount of the reimbursement and transfers the money to the account.
If you find that the costs in the current calendar year exceed the limit, you can apply at any time.
However, there is also the possibility of prepayment.
This is only suitable for people who know for sure that they are burdened with very high expenses for co-payments every year.
The health insurance company calculates the amount of the load limit and provides
bill him.
If this is paid, there is an exemption before the new calendar year has started.
The application can be submitted to the local health insurance company or sent to you.
In general, many health insurance companies offer a digital application process or the option of downloading the applications online.
(mima)
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