Dental Coverage in Public Health Insurance in Germany

Key takeaways

• Public health insurance covers the dental costs of medically necessary treatments only.
• Public insurance doesn’t cover the cost of modern technologies and high-quality materials. Unfortunately, materials and equipment account for 60% of the cost of dental treatment.

This is how you do it

• Ask your dentist for a treatment cost plan. Check with your health insurance company about what costs they cover.
• Get a second opinion for expensive dental treatments.
• Get additional dental insurance to cover the costs not paid by the public insurance company.
• We found Concordia (Zahn Sorglos), Deutsche Familienversicherung AG* (Exclusiv 100), Barmenia* (Mehr Zahn 100 + Mehr Zahnvorsorge Bonus), and Feather* (Advanced) among the best dental insurance plans in Germany as of Aug 2024. Feather is an insurance agent and sells Barmenia’s dental insurance plans.

Table of Contents

Public health insurance in Germany

Everyone living in Germany is legally required to have a health insurance policy. You can choose between public and private health insurance.

Public health insurance covers all the medically necessary treatments. And the same applies when it comes to dental care. 

However, medically necessary treatment is often insufficient for the best dental care. For example, if you choose ceramic tooth filling over amalgam filling, you must pay around 500 € from your pocket.

Federal Joint Committee (Gemeinsamer Bundesaussschuss) determined which dental treatments are sufficient, necessary, and economical for which diagnosis. Public health insurance covers these necessary dental treatments.

Let’s explore what these necessary dental treatments are.

Dental costs covered by public health insurance

Public health insurance providers offer the following dental coverage.

• Dental care
  • Free dental check-ups twice a year
  • Tartar removal once per year
  • Early detection of periodontitis once every 2 years
  • Individual prophylaxis for individuals between the ages of 6 and 18 – e.g., sealing the fissures of the molars (6 and 7)
  • Dental care for children from 30 to 72 months of age
• Dental fillings
  • Front tooth area: plastic fillings in tooth color
  • Posterior area: Amalgam fillings
• Root canal treatment
  • Root canal treatment and removal (resection)
  • Root canal treatment and measurement (X-ray)
  • NOTE: The public insurance provider covers the costs of a root canal only if the tooth is worthy of preservation.
• Periodontitis treatment
  • Systematic periodontitis therapy
  • Pre-treatment (e.g., removal of tartar)
  • NOTE: Public health insurance covers the cost of periodontitis treatment if the periodontal pocket depth is at least 3.5 mm.
• Orthodontics
  • KIG (Kieferorthopädische Indikationsgruppen) reflects the severity of a tooth or jaw misalignment. It has 5 levels, with KIG 1 representing a slight tooth misalignment and KIG 5 the worst. The orthodontist determines the patient’s KIG level based on the KIG guidelines.
  • Public health insurance covers the costs of dental treatments for KIG 3 to 5. There is no insurance coverage for KIG 1 and 2 dental treatments.
  • Removable plastic braces
  • Fixed braces made of stainless steel
  • Costs for the stabilization phase
  • For adults, public insurance companies cover dental services for severe jaw misalignment only.
• Dentures
  • Tooth extraction under local anesthesia. If you desire dental treatment under general anesthesia (200 € to 300 € per hour) or nitrous oxide (100 € to 200 € per hour), you pay from your pocket.
  • Dentures are expensive in Germany. The health insurance company pays a fixed subsidy for denture treatments. The subsidy is 60% of the standard care, which is usually 10 to 20% of the total treatment costs.
  • Examples:
    • A bridge without veneer comes under standard treatment and costs around 660 €. In this case, public health insurance will cover 60% (i.e., 396 €), and you pay 40% (i.e., 264 €) from your pocket.
    • A ceramic implant isn’t considered standard treatment and costs around 3,000 €. The public insurance offers a fixed subsidy of 396 € (60% of standard care), and you pay the rest.

Dental treatments not insured under statutory health insurance

Statutory health insurance doesn’t cover the costs of the following dental treatments.

• Dental care
  • Public insurance companies pay a small subsidy for professional dental cleaning. For example, TK reimburses 40 € once per year for professional cleaning.
  • Fissure sealing for adults or children for teeth (except 6 and 7)
  • Tongue hygiene, oral hygiene
  • Bacterial analysis and DNA test
• Dental fillings
  • Replacement of intact fillings
  • Additional costs for higher quality fillings (ceramic, gold)
• Root canal treatment
  • Public insurers don’t cover the root canal costs if the tooth is unworthy of preservation.
  • Additional costs for modern treatment methods (e.g., CT scan, laser treatment, etc.)
• Periodontitis treatment
  • Long-term follow-up care and preparation for therapy
• Orthodontics
  • No coverage for orthodontics treatments classified as KIG 1 and 2.
  • Internal braces
  • Colorless archwires, plastic and ceramic brackets
  • Fixed retainers on the inside of the teeth
• Dentures
  • No coverage for dental implants. You get a fixed subsidy of 60% of the standard care, which is usually only 10 to 20% of the total dental implant costs.
  • Ceramic or precious metal for crowns and bridges
• Treatment methods
  • Laser treatment, for example, for tooth pocket cleaning or root canal cleaning
  • Functional analysis and functional therapeutic measures
  • Naturopathic procedures (acupuncture, hypnosis, etc.)
  • Aesthetic services: veneers, ceramic veneers, bleaching, etc.

Dental treatments can cost between a few hundred and several thousand euros. Unfortunately, public health insurance doesn’t pay these dental costs.

Thus, you should consider getting supplementary dental insurance policy if you have dental problems or are 35 years old or older.

NOTE: You should not wait to get dental insurance till you have dental problems. Getting a good and cheap dental plan is tough if you have pre-existing dental issues. Moreover, every dental insurance company has reimbursement limits in the first four years.

Does public health insurance pay the dentists in Germany?

Who pays the dentist in Germany depends on the type of dental services you opt for. Dental services can be classified into two types: similar or different dental care.

Similar additional service (Gleichartige Zusatzleistung)

The dental treatments that consist of standard and additional dental care are referred to as similar additional services.

For example, a metal crown in the posterior tooth area is veneered ceramically. In this case, the metal crown is standard care insured under public health insurance. However, ceramic veneer is an additional service that’s not covered by public insurance.

Such dental services fall under similar additional services. 

In similar additional services, the public health insurance provider pays the standard care costs to the dentist directly. And you pay the costs of additional services only.

Different additional services (Andersartige Zusatzleistung)

Suppose you opt for a dental treatment that differs from the one described in the standard care. In this case, the services you opt for come under different additional services.

Example: You opted for a ceramic tooth filling instead of amalgam (standard treatment). In this case, you pay the entire cost of the dental treatment directly to the dentist. 

You can submit the invoice to your public health insurer to reimburse the fixed subsidy.

What are the dentist’s responsibilities in Germany?

Dentists in Germany must advise you about all the available treatments, their risks, costs, and the part paid by the health insurer. You can then choose the dental treatment.

Moreover, dentists cannot refuse you the dental care insured under public insurance.

You can also ask your dentist for a dental treatment cost plan before starting treatment. The cost plan contains the breakdown of the treatments, materials, and laboratory costs. A cost plan can give you a good overview of what costs the most.

The cost of dental treatment varies from dentist to dentist. So you should get a second opinion for expensive dental treatments. Moreover, your health insurer covers the cost of getting a second opinion.

You can also ask your health insurer about the dentists they recommend.

Additional dental insurance to improve dental coverage in Germany

As you know now, public health insurance companies don’t offer comprehensive dental coverage. So, you should get supplementary dental insurance in Germany to have full dental coverage.

Good dental insurance plans cover up to 100% of dental costs. However, the insurer applies a few conditions to protect itself.

• There is a reimbursement limit period of 4 to 5 years when you take a dental insurance policy. During this period, the insurer limits the maximum reimbursement amount for certain treatments.
• Dental insurance providers don’t cover the costs of existing dental problems.
• The dental insurance premium increases with age, regardless of whether you have a dental problem.
• Dental insurance companies reject applications from individuals with existing dental issues.

NOTE: The dental insurance premium doesn’t increase if you develop dental problems after taking the insurance.

Getting a good and cheap dental insurance plan is tough if you have existing dental diseases. Thus, you must get supplementary dental insurance before you develop one. You should consider getting a dental insurance plan if you are 

• a smoker, 
• 35 or above,
• have existing dental problems.

In our research, we found

• Concordia (Zahn Sorglos)
• Deutsche Familienversicherung AG* (Exclusiv 100),
• Barmenia* (Mehr Zahn 100 + Mehr Zahnvorsorge Bonus),
• and Feather* (Advanced)

among the best dental insurance plans in Germany as of 2024. You can read how we found the best dental insurance plans here.

NOTE: Feather is an insurance agent and sells Barmenia’s dental insurance policies. The benefit of taking insurance from Feather is that you can file claims and get customer support in English.

References

• https://www.zahnzusatzversicherung-experten.de/ratgeber-kinder-kig-einstufung.html
• https://www.zahnversicherung-online.de/ratgeber-zahnzusatzversicherungen/zahnarzt-was-bezahlt-die-krankenkasse-die-gesetzlichen-kassenleistungen-im-ueberblick
• https://www.test.de/Gesetzliche-Krankenversicherung-Alle-Infos-zum-Thema-Krankenkassen-1151006-1152041/
• https://www.lebenshilfe.de/informieren/familie/rund-um-den-mund/zahnersatz-was-zahlt-die-krankenkasse