Prescription medication, physiotherapy or even a hospital stay – so-called co-payments have to be made everywhere. This can cost a lot of money. But what very few people know: The additional payments for medication etc. are capped. And this also applies to recipients of citizen’s benefit. Read what you need to know in this article.
By the way: Citizens’ benefit recipients get some things for free.
Citizens’ money: Are medications covered by the job center?
In almost all cases, medication and other medical services are not covered by the job center. The health insurance companies are responsible for this. Because recipients of citizen’s benefit usually also have statutory health insurance.
Are citizens’ benefit recipients exempt from additional medication payments?
Citizen benefit recipients are not automatically exempt from additional payment for medication. Because there is a so-called load limit up to which those receiving citizen’s benefit have to cover the costs themselves. According to the consumer advice center, the limit is two percent of the gross income of all people living in the household per calendar year. For chronically ill people, the limit is one percent.
According to the consumer advice center, there is a special regulation for calculating the load limit for recipients of social assistance – which also includes citizen’s benefit. This is going to be loud patientenberatung.de calculated from the standard needs for an adult (standard needs level 1) for the entire community of needs.
The calculation: According to the consumer advice center, the monthly standard rate for citizens’ money – for 2023 this was 502 euros – is multiplied by twelve in order to calculate the annual gross income. In 2023 this was 6,024 euros. This sum was multiplied by 0.02 to determine the annual burden limit (two percent of annual gross income). This corresponded to 120.48 euros for 2023. For chronically ill people, the sum was multiplied by 0.01, because the load limit then only accounts for one percent of the annual gross income and was therefore 60.24 euros for citizens’ benefit in 2023.
The citizen’s allowance was increased on January 1, 2024. As a result, the annual load limit also increased. Because the standard requirement for an adult in standard level 1 has increased to 563 euros, the burden limit has increased from 2024 to 135.12 euros for citizens’ benefit recipients and to 67.56 euros for chronically ill people.
Citizens’ money: What additional payments must be made?
The additional payments that those with statutory health insurance must pay are fixed. At prescription medications as well as aids and bandages, the additional payment is 10 percent – at least 5 euros and a maximum of 10 euros. If the product costs less than 5 euros, the entire cost must be borne by yourself. 10 percent also applies to aids that are intended for consumption. However, a maximum of 10 euros per month. If a medication is particularly cheap and is at least 30 percent below the fixed amount set by the health insurance company, the insurance company will reimburse the costs, writes the AOK. You must pay for medications that are not prescribed by a doctor yourself.
In addition to medication and aids and bandages, other things are also included in the medical services that require additional payment:
-
Full inpatient treatment in hospital: 10 euros per day, but a maximum of 28 days per year. Inpatient deliveries are free of charge.
-
Home nursing: Ten percent of all costs for the first 28 days of a calendar year and 10 euros per prescription.
-
Household help: Ten percent of all costs per day. However, at least 5 euros and a maximum of 10 euros per day. There is no additional payment in the event of pregnancy or childbirth.
-
Sociotherapy: Ten percent of all costs, but a minimum of 5 and a maximum of 10 euros per day.
-
Remedies (e.g. physiotherapy): Ten percent of all costs and 10 euros per prescription.
-
Rehabilitation: 10 euros per day, up to a maximum of 28 days per year. This includes days of previous hospitalization.
-
Mother/father-child treatment: 10 euros per day.
-
Where: Ten percent of all costs for remedies and 10 euros per prescription for outpatient treatment. Inpatient preventive and rehabilitation treatment: 10 euros per day.
Citizens’ allowance: When are you exempt from paying additional medication?
If the additional payments have already reached the limit, recipients of citizen’s benefit can apply for an exemption. This then applies for the rest of the calendar year and expires at the turn of the year. If the application is approved, the people will receive an exemption card. This is also only valid until the end of the current calendar year.
As the AOK writes on its website, the following documents are required to apply for exemption from the additional payment:
-
All receipts for the additional payments already paid. Important: Your personal data must be noted on this. The AOK also notes that proof of payment is also required for bills such as hospital co-payments. For example, a bank statement can be used for this.
-
Copies of proof of income: This includes, among other things, a current pension notice or the citizen’s benefit or basic security notice.
-
Anyone who has a chronic illness needs confirmation from their treating doctor.
By the way: There have been some changes to citizens’ money since July 1, 2023. And then there are also new rules for additional income from citizens’ benefit. Students can also be entitled to citizen’s allowance.
