Few questions concern patients as much as the cost of treatment – and few topics are as confusing. That's down to the system: for dental prosthetics, German statutory health insurance does not pay a percentage of your bill. It pays a fixed amount determined solely by your clinical findings.
On this page we explain how that system works, what determines the size of your own contribution, and where you can influence it yourself. The concrete figures for your case are always set out in the treatment and cost plan you receive from us before any treatment – no treatment that incurs costs begins here without your agreement.
A note on this page: it deliberately contains no euro amounts. Dental prosthetic costs depend on your individual findings and insurance status, so any figure quoted here would be misleading. You'll receive your actual numbers in writing before treatment begins.
The fixed-subsidy principle
The key sentence to understand: the subsidy is based on your findings, not on the treatment you choose. For the same findings, your insurer therefore always pays the same amount – regardless of whether you opt for the simplest or the highest-quality solution.
Standard care (Regelversorgung)
The medically adequate standard treatment for your findings. Here the fixed subsidy covers most of the cost; a manageable own contribution remains.
Similar care (gleichartige Versorgung)
Standard care plus additional services – for example a tooth-coloured facing where your insurer doesn't provide for one. You receive the same fixed subsidy and cover the additional cost.
Different care (andersartige Versorgung)
A fundamentally different solution from standard care – an implant instead of a bridge, for instance. Here too the fixed subsidy stays the same; billing follows the private fee schedule.
In practice this means: a higher-quality treatment costs you the difference – not a multiple. Whether that premium is worthwhile in your case is something we discuss openly and without pressure.
Your bonus booklet – the most effective lever
Since October 2020 the basic subsidy has been 60 percent of the cost of standard care. Anyone who attends check-ups regularly and documents this in their bonus booklet (Bonusheft) receives more:
For adults, one check-up appointment per calendar year is enough; for children and adolescents between 6 and 18 it's two. Have every appointment stamped in the booklet – the check-up itself is covered by statutory insurance and costs you nothing, but it noticeably reduces your own contribution later. And a lost bonus booklet can often be reconstructed: just ask us.
The treatment and cost plan
Before any dental prosthetic work is made, you receive a treatment and cost plan (Heil- und Kostenplan) from us. It is your cost certainty – and required by law.
- Findings and planning. We examine, discuss the possible treatments with their pros and cons, and record the chosen solution in writing.
- You receive the plan. It sets out the findings, the planned treatment, the expected fixed subsidy and your remaining own contribution.
- Your insurer reviews it. You submit the plan and your insurer confirms the subsidy. This usually takes a few days to a few weeks.
- Only then does work begin. Treatment starts after approval – so you know in advance what to expect.
What your insurer covers – and what it doesn't
Usually covered by statutory insurance
- Check-up examinations (once a year, for the bonus booklet)
- Scale and polish once per calendar year
- Fillings within the scope of contracted dental care
- Root canal treatments, provided the tooth is worth preserving
- Systematic periodontal treatment where the findings warrant it
- Early detection and preventive care for children and adolescents
- Fixed subsidy towards dental prosthetics, based on findings
Private services
- Professional teeth cleaning – though many insurers contribute towards it
- Whitening and purely cosmetic treatments
- Veneers
- Aligner treatment for adults
- Additional costs for higher-quality crowns, bridges and implants
- Composite fillings beyond the covered scope
Ask your health insurer specifically about bonus programmes – many now reimburse professional teeth cleaning fully or in part. Supplementary dental insurance can also substantially reduce your own contribution; it only makes sense, however, while no treatment need has yet arisen.
If your own contribution isn't affordable
For insured people on a low income, the hardship provision (Härtefallregelung) applies: your insurer then covers the full cost of standard care. Income thresholds, which are adjusted annually, are decisive – and if your income is only slightly above them, partial reimbursement is possible (the so-called sliding hardship provision).
Please speak to us openly if cost is a problem. It isn't an awkward question, it's a practical one – and we can often find a medically sensible solution together that fits your situation.