What are “Heilmittel” and “Hilfsmittel” in Germany?

Generally speaking, the German word "Heilmittel" describes treatments that do not involve the use of medication and are applied to the outside of the body. In the German healthcare system, though, the word mainly has a different meaning: It is used to describe specific treatments that are not carried out by a medical doctor and that are paid for by public health insurers. These treatments can be prescribed by a doctor in order to treat an illness, to prevent it from getting worse, or to relieve symptoms. They may also be used to prevent illnesses from developing in the first place and, for instance, to help prevent developmental disorders in children or the need for nursing care in elderly people.

The following treatments can be prescribed as Heilmittel by doctors in Germany:

• Occupational therapy (Ergotherapie)
• Physical therapy (Physiotherapie)
• Speech therapy (Logopädie – including voice therapy and swallowing therapy)
• Specialist foot care (Podologie)
• Nutritional therapy (Ernährungstherapie)

Only certified healthcare professionals who have the proper training are allowed to offer these Heilmittel therapies. They mainly include:

• Occupational therapists
• Physical therapists (physiotherapists)
• Massage therapists
• Hydrotherapists (healthcare professionals who use water to treat medical problems)
• Speech therapists
• Podiatrists (foot care specialists)
• Nutritional therapists

If your doctor thinks that one of these Heilmittel treatments will help, they will prescribe it for you. Occupational therapy can be prescribed by psychotherapists, too. The prescription usually states how many treatment sessions the doctor has prescribed and how often they should take place. That will depend on the illness and the type of treatment. Once you have a prescription, you can make appointments with a suitable healthcare professional. If the symptoms still haven’t gone away after the last appointment, the doctor can prescribe more sessions.

Since 2024, doctors have also been able to issue a more flexible prescription (Blanko-Verordnung) for occupational therapy. This gives the therapist more freedom to decide what kind of therapy they do, and for how long. In the future it will probably be possible for doctors to issue this kind of flexible prescription for other Heilmittel treatments, too.

Heilmittel therapies are often part of the treatment received at inpatient treatment facilities, like rehabilitation centers. Then public health insurers cover all the costs of this treatment. But if you’re prescribed a Heilmittel treatment in an outpatient setting, you have to pay part of the costs yourself. That part is 10 euros per prescription plus 10% of the treatment costs. So for treatment costs of 180 euros, the amount you would have to pay would be a total of 28 euros (10 + 18). You don’t have to pay if the prescription is for a child or teenager, though. Public health insurers always cover the costs of Heilmittel treatments up until the age of 18.

Normally, the treatment has to start within 28 days of the date on the prescription. After that, the prescription is no longer valid. Sometimes, if the treatment is needed more urgently, it must start within 14 days. That is then specifically stated on the prescription. The prescription also becomes invalid if the patient doesn't show up for treatment over a period of more than 14 days without giving a reason.

If you have private health insurance, the costs covered will depend on your policy. It is best to check with your insurer first.

The healthcare professionals might also offer treatments that you have to pay for yourself.

In the German healthcare system, Hilfsmittel are defined as products that are mainly used to help people cope better in daily life if they have an illness, a disability or need nursing care. These aids include glasses, hearing aids, artificial limbs, wheelchairs, nursing beds, bath seats and disposable supplies like syringes and bandages. Hilfsmittel aids can help to

• treat illnesses,
• prevent or compensate for disabilities and the need for nursing care,
• avoid developmental disorders in children (using a hearing aid, for example),
• provide nursing care, and
• support people who need nursing care.

The term “Hilfsmittel” covers many different products for a range of very different health problems. The website of the German National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) has a list of Hilfsmittel medical aids that public health insurers will pay for in full or in part.

These aids can be prescribed by your doctor. Once you’ve got the prescription, you can take it to a supplier of that kind of medical aid. Depending on what you need, suppliers include:

• Opticians, e.g. for glasses
• Audiologists (Hörgeräteakustiker), e.g. for hearing aids
• Medical supply stores (Sanitätshaus), e.g. for elastic bandages, inhalers, walking aids, bathing aids and incontinence products
• Orthopedic technicians, e.g. for artificial limbs and braces
• Podiatrists (medizinische Fußpflege/Podologie), mainly for foot and toe pads
• Orthopedic footwear specialists, e.g. for insoles and made-to-measure orthopedic shoes
• Pharmacies, for things like incontinence products, bandages, compression stockings, and devices to measure blood pressure or blood sugar

If you don’t need these medical aids for very long, you can sometimes borrow them from a health insurer or supplier. For instance, if you’re recovering from an acute illness and need a wheelchair for a while, you can borrow it and return it later.

Some medical aids, like glasses or insoles for shoes, have to be adjusted especially for you. For others, you need to attend training to learn how to use them properly. Examples include breathing masks and machines designed to make sure heavy snorers don’t temporarily stop breathing when they’re asleep (sleep apnea). In some of these cases, the health insurer won’t pay for the medical aid until you’ve done the training.

That depends on what they’ve been prescribed for. For instance, is the aim to relieve symptoms, make nursing care easier, or help you to continue working? Usually, your health insurer or nursing care insurer (Pflegeversicherung) pays – but it could also be your pension fund (Rentenkasse), accident insurance provider (Unfallversicherung), the employment agency (Arbeitsagentur) or the social welfare office (Sozialamt).

If your public health insurer covers the costs, you have to pay part (10%) of the price of the Hilfsmittel aid yourself. Known as a co-payment, this will be at least 5 euros and at most 10 euros. For example, if the medical aid costs 70 euros, you’ll have to pay 7 euros. The co-payment isn’t allowed to be more than the price of the medical aid, though. If the aid costs less than 5 euros, you will have to pay for it yourself. If the prescription is for disposable supplies such as bandages or syringes, the co-payment is limited to 10 euros per month.

For some Hilfsmittel, though, public health insurers will only cover the costs up to a fixed amount (Festbetrag). If you opt for a more expensive aid of this type, you will have to pay the additional costs as well as the co-payment. This applies to the lenses of glasses, for example.

If you’re prescribed a Hilfsmittel medical aid, you must buy or order it within 28 days of the prescription date. After that, the prescription is no longer valid. As with Heilmittel treatments, children and teenagers under the age of 18 don’t have to pay anything for Hilfsmittel aids. Public health insurers cover all of the costs.

Private health insurance companies have different rules when it comes to covering the costs of Hilfsmittel aids. It is best to check with your own health insurer first.

If you need nursing care and are prescribed a Hilfsmittel aid, your nursing care insurer (Pflegeversicherung) will cover the costs. You then have to pay 10% of the price yourself, but no more than 25 euros. If a Hilfsmittel aid is needed both for nursing care and treatment, the costs are sometimes divided between the nursing care insurer and the health insurer.

These rules may be different if the costs are covered by pension funds, accident insurance providers, the employment agency or the social welfare office.