Dental Treatment, Dentures, Fillings, and Braces

Visits to the dentist are usually associated with co-payments for people with statutory health insurance. For example, statutory health insurance companies only pay fixed subsidies for dental prostheses. However, this subsidy for dentures does not cover the whole cost. For this reason, many insured persons take out supplementary dental insurance which reimburses the additional expenses.

Dental prostheses
The subsidy amount paid by health insurance is not based on the treatment method but on the dental diagnosis. Statutory health insurance pays a fixed allowance based on the diagnosis, regardless of whether the insured person opts for a simple or complex treatment. The statutory health insurance subsidy remains the same regardless of which dental treatment is chosen. Fifty percent of the costs for standard care are covered. The allowance increases to 70 to 80 percent if the patient has been going to preventive checkups.

Dental prostheses are crowns, bridges, removable dentures, and implants. Let's assume the dental diagnosis is a gap with one missing tooth. In standard care, the missing tooth is compensated by a bridge. Patients could also opt for a different, more complex treatment, for example, an implant-supported denture that replaces the missing tooth. However, such a solution is significantly more expensive than a bridge.

For a dental prosthesis that deviates from the standard treatment, the patient bears the additional costs that arise. The dentist prepares a treatment and cost plan before treatment begins. This includes the diagnosis, the standard treatment, and the actual planned dental prosthesis in terms of type, scope, and cost. The statutory health insurance checks the treatment and cost plan before treatment begins. The statutory health insurance company approves the fixed allowance according to the diagnosis presented in the treatment and cost plan.

If the patient has been going regularly to preventive checkups in the previous five years, the dental prosthesis allowance increases by 20 percent. If the patient has been going regularly to preventive checkups in the previous ten years, the dental prosthesis allowance increases by 30 percent. Insured persons with low income – for example, recipients of social welfare, unemployment benefits, or educational grants – receive the standard treatment free of charge.

Dental fillings
For anterior teeth, statutory health insurance funds cover the cost of tooth-colored composite fillings. Patients with special aesthetic requirements for the composite filling, such as color optimization, must pay additional costs. In the case of posterior teeth, statutory health insurance only covers the cost of amalgam fillings. However, amalgam fillings are prohibited for children under 15, pregnant women, and nursing mothers. Amalgam fillings may also not be used in the case of an amalgam or mercury allergy. The statutory health insurance will then cover the cost of a composite filling.

Patients can choose to have a filling material other than amalgam. Those with statutory health insurance must bear the additional cost themselves. To protect yourself against this risk, you can take out supplementary dental insurance.

Preventive care and professional teeth cleaning
Statutory health insurance covers the cost of two dental checkups a year for adults and children over the age of 6. Tartar removal is also paid for. Periodontal checkups are provided every two years for the early detection of periodontitis. For children between the 6th and 34th months, there are three early detection checkups by a dentist. Between the ages of 3 and 6 years, there are three additional checkups.

Preventive checkups are entered in a “bonus booklet”. In the case of children, two checkups per year must be certified, and in the case of adults, one checkup per year. Those who provide evidence of regular preventive checkups receive higher subsidies for dental prostheses.

Professional teeth cleaning is not covered by statutory health insurance. Nevertheless, many statutory health insurance funds grant some subsidies. Supplementary dental insurance often covers the cost in full.

Braces
The correction of pronounced malocclusions using braces is covered by statutory health insurance up to the age of 18 if it is medically necessary. An orthodontist determines the malocclusion and submits a treatment and cost plan to the statutory health insurance provider. The severity of the malocclusion is measured by the orthodontic indication groups (KIG). These range from mild (KIG 1 and 2) to severe disorders (KIG 5). Malocclusions in KIG 1 or 2 are considered purely aesthetic and are not covered by statutory health insurance.

The orthodontist may offer additional services that parents pay for themselves. In any case, parents should consult their statutory health insurance fund before signing a cost agreement. The statutory co-payment of the treatment cost for braces is 20 percent. For siblings treated at the same time, it is 10 percent.

After the successful completion of the treatment, the share of the costs paid by the parents is refunded. If the treatment is canceled, the co-payment is lost. After the treatment is completed, the orthodontist issues a certificate of completion, which the parents then submit along with the invoices to the statutory health insurance provider.

Lingual braces are very similar to regular fixed braces, except they are placed on the insides of the teeth. So, from outside, lingual braces can hardly be seen and allow for "invisible" teeth straightening. As an aesthetic solution, statutory health insurance does not cover lingual braces. The difference in the cost compared to conventional fixed braces is covered by the parents.