For dental prosthetics, statutory health insurance (gesetzliche Krankenkasse) only pays a fixed subsidy of 60% of the standard care (Regelversorgung; 70% or 75% with a bonus booklet) – with high-quality prosthetics such as implants, a large part of the bill is often left for you to pay. A supplementary dental insurance can close this gap. Pay particular attention to the reimbursement for dental prosthetics, the Zahnstaffel (reimbursement caps) in the first years and any waiting periods.
What does supplementary dental insurance cover?
For dental prosthetics (crowns, bridges, implants), statutory health insurance only pays a fixed subsidy based on the diagnosis (befundbezogener Festzuschuss): 60% of the cost of the so-called standard care (Regelversorgung), or 70% (5 years) or 75% (10 years) with a continuously kept dental bonus booklet (Bonusheft). If you choose more elaborate treatment such as implants, the subsidy stays the same – you pay the rest yourself, and that quickly runs into the thousands. Depending on the plan, supplementary dental insurance reimburses up to 100% of the remaining costs and often also covers professional teeth cleaning (PZR) and high-quality fillings.
What to look out for when comparing
- Reimbursement for dental prosthetics – the most important figure. Good plans reimburse 80–100% including the health insurance subsidy.
- Zahnstaffel (graduated reimbursement caps) – in the first years, reimbursement is usually capped (e.g. max. €1,000 in the 1st year). The earlier you take out a policy, the better.
- Waiting period – many plans only pay out after 3–8 months; some waive this. Treatment that has already been recommended is not covered.
- Health questions – missing teeth and ongoing treatment can lead to surcharges or rejection.
- Dental treatment & PZR – look for reimbursement of root canal treatment, composite fillings and professional teeth cleaning 1–2× per year.
When is supplementary dental insurance worthwhile?
It is worthwhile for almost anyone with their own teeth – especially before problems arise. If you go for professional teeth cleaning regularly and want high-quality dental prosthetics, a good plan will quickly save you more than you pay in premiums. Important: take out a policy early (young entry age = low premium, no missing teeth) and not only when the crown is already due.
What the statutory health fund actually pays for dental prosthetics
The basis is the fixed-subsidy system under section 55 of Book V of the Social Code (SGB V). Before treatment the dentist draws up a treatment and cost plan that defines the so-called standard care for each finding. The health fund pays 60% of the cost of this standard care as a fixed subsidy, or 70% or 75% if your bonus booklet has been kept without gaps. For insured people on low incomes the law provides a hardship rule under which the standard care is covered in full.
The fixed subsidy stays the same even if you opt for higher-quality treatment, for example an implant instead of a bridge. You pay the difference yourself. Laboratory and material costs come on top and are billed by the dentist under the German dental fee schedule (GOZ). The GOZ allows the base rate to be multiplied by a factor; 2.3 times is usual, and up to 3.5 times is possible with a justification for difficult treatments. It is precisely this part that the statutory fund does not cover.
A worked example with freely chosen sample values: a crown is billed at €1,200 and the standard care for it is set at €500. At 60%, the fixed subsidy is €300, and €375 with a 75% bonus. Without supplementary insurance you are left with €825 to €900 out of pocket. If a plan refunds, say, 90% of the bill including the fund's share, that is €1,080, and your own share falls to €120. The values that apply to you are in the treatment and cost plan and your plan's terms.
Understanding the staggered scale, waiting periods and benefit limits
Most plans cap reimbursement in the first years of the contract through a staggered scale (Zahnstaffel). The maximum amounts rise year by year and apply cumulatively to all benefits. If you need expensive dental prosthetics shortly after taking out the policy, you therefore receive only part of the costs. Accident-related treatment is usually exempt. Check in the terms whether the scale applies only to prosthetics or also to dental treatment and preventive care.
There are also waiting periods in which no benefits are paid yet. What counts is when the treatment starts, not when the bill arrives. Many insurers refuse benefits for treatment that was already recommended or planned before the contract began. A treatment and cost plan drawn up before the start of cover is therefore a frequent point of dispute. Keep all dental records and answer health questions carefully.
It is also worth looking at the reimbursement basis. Some plans refund only up to the GOZ base rate, others up to the maximum rate, and material and laboratory costs are subject to separate caps. The number of teeth cleanings refunded and the amount per session are also regulated differently. So compare not only the percentage but also what it refers to.
Health questions, entry age and premium development
When you apply you must answer health questions about missing teeth, ongoing treatment, periodontitis or jaw joint problems. The pre-contractual duty of disclosure under sections 19 et seq. of the German Insurance Contract Act (VVG) requires complete and truthful answers. If you withhold something, the insurer can withdraw from the contract or refuse benefits. Where teeth have already been restored, ask your dentist for an extract from your patient file instead of answering from memory.
The premium depends on your entry age and generally rises as you get older, partly in age bands and partly through premium adjustments. Taking out a policy early secures lower premiums and avoids missing teeth becoming grounds for exclusion. The calculator of our partner financeAds shows what the premium is for your age and plan.
A long-term contract does not necessarily tie you down. Many providers allow cancellation at the end of the insurance year, some even monthly. Note, however, that if you switch you have to answer health questions again and a new staggered scale and waiting period begin. Only switch if the new plan is clearly better.
Step by step to the right plan
Start by taking stock: which teeth have already been replaced, which treatments are foreseeable and how important are implants or preventive care to you? This tells you whether a pure dental-prosthetics module is enough or whether a plan that includes dental treatment and teeth cleaning makes more sense. Then decide what share of the cost you could bear in a worst case.
Next, calculate the premium for your age with two or three providers and compare the terms side by side: reimbursement level, staggered scale, waiting period, maximum rates and preventive benefits. Ask for the insurance terms and the product information sheet before signing. After concluding the contract you have a statutory right of withdrawal of 30 days under section 8 VVG, provided you have received the documents.
Before major treatment, submit the treatment and cost plan if your insurer requires it, and wait for the reply. That way you know in advance how much will be reimbursed and avoid unpleasant surprises. Keep invoices and your bonus booklet safe, as both prove your claim.