Orthopaedic shoes: co-payment from the Jobcenter — how to fight back against the denial

The health insurance has covered part, but the co-payment for your orthopaedic shoes is 250, 400 or 500 euros. From Bürgergeld you cannot pay that. You filed an application with the Jobcenter — and then came the denial. In many cases that is not legally tenable.

The essentials in 30 seconds

  • Co-payments for orthopaedic shoes, insoles and diabetic protective shoes can be covered by the Jobcenter as therapeutic equipment under § 24 Abs. 3 Satz 1 Nr. 3 SGB II.
  • The Jobcenter may not refer you on a blanket basis to the health insurance if the insurance has already paid its standard rate and the co-payment remains.
  • The surcharge is not included in the standard requirement (Regelbedarf) — the Federal Social Court has confirmed this several times.
  • Typical co-payments range, depending on manufacturer and equipment, between 100 and 500 euros per pair, for custom-made shoes significantly higher.
  • Against the denial you have one month appeal period (Widerspruchsfrist) from receipt of the decision.

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Why does this happen?

Orthopaedic footwear is expensive. A pair of custom-made orthopaedic shoes quickly costs 1,500 to 2,500 euros at the orthopaedic store. The statutory health insurance pays according to fixed amounts. Anything beyond that — better materials, special adaptations, a second pair per year — is left to the insured as a co-payment.

For people on Bürgergeld this is unaffordable. The standard requirement (Regelbedarf) (563 euros for single adults, as of 2025) covers food, electricity, clothing and hygiene. A buffer for medical co-payments in the three-digit range is simply not provided for in it.

This is precisely what § 24 Abs. 3 SGB II exists for: one-off needs that lie outside the standard requirement. Number 3 of this provision expressly mentions therapeutic devices and equipment as well as their repair (therapeutische Geräte und Ausrüstungen). Orthopaedic shoes legally belong to this category.

The Jobcenter knows the provision — but often denies with blanket phrases. Typical reasoning:

  • "The health insurance is responsible for that."
  • "That is included in the standard requirement, you have to build a reserve."
  • "You have already received shoes once, another pair is not necessary."
  • "There are cheaper models, the surcharge is not appropriate."

Example: Herr Özcan, 58, suffers from diabetes mellitus with diabetic foot syndrome. His orthopaedist prescribes diabetes-adapted protective shoes. The health insurance pays 150 euros fixed amount per pair. The orthopaedic technician charges 420 euros co-payment. Herr Özcan applies for the 420 euros at the Jobcenter. The denial arrives after three weeks: "Health insurance benefits are not covered by SGB II." That is legally wrong — because it is not about the insurance benefit, but about the co-payment going beyond it.

Your rights in detail

1. Legal basis: § 24 Abs. 3 Satz 1 Nr. 3 SGB II. The provision names as a one-off need: "Acquisition and repairs of therapeutic devices and equipment as well as rental of therapeutic devices." Orthopaedic shoes, insoles, adaptations and diabetic protective shoes undisputedly fall under this — they serve therapy or the prevention of disease progression.

2. Distinction from the health insurance. The insurance benefit is regulated in §§ 27 ff. SGB V. The insurance pays a fixed amount or a percentage share. Anything above that is no longer an insurance matter — and thus lands at the Jobcenter, insofar as medical necessity exists. This is precisely the central lever: the co-payment is not double-insured, it is only insured once — at the Jobcenter.

3. Distinction from the standard requirement. The standard requirement contains an item "Healthcare". However, it covers only smaller, regularly recurring expenses: non-prescription ointments, toothbrushes, plasters. Therapeutic aids in the three- or four-digit range are not covered by it. The Federal Social Court has repeatedly emphasised that one-off, high health needs lie outside the standard requirement.

4. No more delineation from glasses needed. Since the legislative change in 2017, the health insurance again covers vision aids for adults with certain visual acuities as an insurance benefit. This does not affect orthopaedic shoes. Here the fixed amount plus co-payment remains — and thus the Jobcenter's responsibility for the additional cost portion.

5. Two pairs per year are possible. Where medical necessity is documented — e.g. with strongly sweating feet, heavy wear or diabetes — a second pair per year is legally recognised. The orthopaedist must justify this comprehensibly. The Jobcenter may not fob you off with the reference "one-off need" if the doctor certifies a multiple need.

6. Check proportionality. The Jobcenter can suggest an in-kind benefit (direct billing with the orthopaedic technician) or a cheaper provider. But this must be concretely realistic — not simply "go elsewhere." If only one orthopaedic technician within reasonable distance provides care, the Jobcenter cannot refer you to a fictitious alternative.

Current case law

The Federal Social Court has consolidated the line that § 24 Abs. 3 SGB II covers one-off health needs that the health insurance does not fully reimburse and that noticeably exceed the standard requirement. Therapeutic aids such as orthopaedic shoes or insoles above the insurance fixed amount are accordingly to be borne by the Jobcenter if medical necessity is documented [URTEIL-REFERENZ].

On the delineation of standard requirement vs. one-off need, the BSG has clarified: high one-off health expenses that cannot realistically be saved up from the standard requirement do not belong to the flat-rated need, but are to be examined as a special benefit [URTEIL-REFERENZ]. The argument "you have to save up for that" therefore does not apply for co-payments amounting to several hundred euros.

The social courts also require the Jobcenter to examine in the individual case whether in-kind benefit, cheaper manufacturer or direct billing would be a realistic alternative. A mere blanket denial "too expensive" does not suffice [URTEIL-REFERENZ].

How to proceed now

Step 1 — Mark the deadline in the calendar. The denial decision states the date of receipt. From that day you have one month for the appeal. Mark the last day in bold. Missed deadline = final decision.

Step 2 — Collect documents. You need three documents:

  • Medical prescription or orthopaedic order (often on form 8)
  • Cost estimate from the orthopaedic technician or medical supply store, broken down into insurance share and co-payment
  • Insurance decision or settlement of the health insurance about the fixed amount paid

Without these three papers, any argumentation is weak.

Step 3 — Submit the appeal. The appeal must be in writing and signed. A simple deadline-saver suffices in the first step:

"I hereby lodge an appeal (Widerspruch) against the decision of [date], file number [number]. Reasoning will follow within three weeks. I request file inspection (Akteneinsicht)."

Step 4 — Submit the reasoning. Refute the concrete denial reasoning. Was reference made to the health insurance? Attach the insurance decision showing the remaining co-payment. Was reference made to the standard requirement? Calculate it: your co-payment (e.g. 420 euros) corresponds to 75 percent of one month's standard requirement — that cannot be saved up.

Step 5 — Document medical necessity. Ask your orthopaedist for a detailed reasoning (not just the standard prescription). Keywords: diagnosis, loss of function without the shoe, looming consequences (e.g. amputation risk in diabetes), why standard care does not suffice.

Step 6 — Monitor the Jobcenter's deadlines. The Jobcenter is to decide on the appeal "within a reasonable time". After three months of inactivity you can file an inactivity action (Untätigkeitsklage) at the social court free of charge (§ 88 SGG). The mere announcement moves many authorities.

Common mistakes to avoid

  • Buying shoes first, then applying. As long as no approval decision exists, you risk being stuck with the costs. Only in acute emergencies (e.g. open wounds, documented amputation risk) is there subsequent reimbursement.
  • Letting yourself be fobbed off with "the health insurance pays". That is exactly the point that the Jobcenter does not legally separate cleanly. The co-payment is not an insurance matter once the fixed amount is exhausted.
  • Letting yourself be referred to the standard requirement. A reserve of 400 euros is not feasible from 563 euros monthly need. Push back.
  • Accepting verbal information. "Doesn't work" on the phone or at the counter is legally worthless. Insist on a written decision — only this is appealable.

Frequently asked questions

Doesn't the health insurance have to decide conclusively first before the Jobcenter examines?

Yes, the order is important. First you apply for the care from the health insurance. Once the insurance decision with the fixed amount is in hand, the co-payment is fixed. Only then does the application to the Jobcenter make sense. Submit the insurance decision with the application to the Jobcenter — otherwise it will say: "First wait for the health insurance."

Do orthopaedic insoles also count or only complete shoes?

Insoles, adaptations to off-the-shelf shoes and orthoses fall under therapeutic equipment under § 24 Abs. 3 Satz 1 Nr. 3 SGB II in the same way. What counts is the medical prescription, not the item itself. Repairs are also expressly covered.

What if I need two pairs every year?

In case of medical necessity — e.g. heavy wear in diabetes or severe foot complaints with sweating — a second set per year is permissible. The orthopaedist must justify this in writing. The Jobcenter may not deny on a blanket basis with the reference "one-off need" if the need arises regularly multiple times.

Can the Jobcenter force me to accept an in-kind benefit?

The Jobcenter can also bill directly with the medical supply store instead of cash benefit (§ 24 Abs. 3 Satz 5 SGB II). This is permissible as long as your need is met. If the only named medical supply store is far away or cannot deliver the care, you can insist on another way.

Do I need a lawyer for the appeal?

No. The appeal is informal and to be done by yourself. Lawyer's help is worthwhile if the Jobcenter rejects the appeal and a lawsuit is pending. For the appeal procedure there is legal counselling assistance (Beratungshilfe) — you get a counselling assistance certificate free of charge at the local court (Amtsgericht).

Have your decision reviewed now

A denial for orthopaedic shoes is rarely legally sound. The Jobcenter often confuses insurance benefit and co-payment, cites the standard requirement incorrectly or refuses the individual review. With co-payments of 250 to 500 euros — significantly more for custom-made shoes — the review pays off in almost every case.

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