Dental care

Statutory insurance covers dental treatment that is sufficient and appropriate to prevent, identify and treat disease of the teeth, mouth and jaw. For replacement teeth, the insurer normally pays a fixed subsidy towards standard care. If you qualify under the hardship rules, standard care can be covered in full; you pay the cost of upgrades.

In short

• If you choose a higher-cost filling, you pay the extra above the cheapest comparable filling placed and shaped directly in the tooth (plastische Füllung). You and the dentist must agree the additional cost in writing before the higher-cost treatment begins.
• Until 31 December 2026, the Festzuschuss for medically necessary crowns and dentures is 60 percent of the standard-care amounts. It rises to 70 percent with the five-year check-up record and to 75 percent with the ten-year record. From 1 January 2027 those shares are 50, 60, and 65 percent. An approval before 1 January 2027 keeps the earlier shares. Those shares are not shares of an unlimited bill.
• A missing check-up in 2020 does not remove either bonus. The insurer can accept one other gap in the ten-year record for the ten-year bonus in a justified exceptional case.
• If your income is low, ask the insurer about section 55 (2) and (3) before you sign. Full standard-care coverage applies to recipients of Grundsicherungsgeld (Bürgergeld until 1 July 2026), BAföG, or assistance under Book XII. It also applies when monthly gross household receipts do not exceed 40 percent of the monthly reference amount for one person, plus 15 percent for the first relative in the household and 10 percent for each further relative. A sliding scale under section 55 (3) applies just above that threshold. A qualifying full hardship covers standard care in full, subject to the actual cost: 60 percent plus 40 percentage points until 31 December 2026, and 50 percent plus 50 percent from 1 January 2027. If someone qualifying for full hardship chooses a more expensive restoration, the insurer’s contribution is limited to the standard-care amount, and they pay costs above it. A sliding-scale contribution can be lower.
• Private insurance follows its contract. Ask the statutory insurer before you pay a private dentist and send that invoice as if section 55 applied unchanged.
• A supplementary dental policy, Zahnzusatzversicherung, is voluntary. BaFin’s consumer brochure describes it as a private contract for costs the statutory scheme does not pay. It does not change the statutory shares; ask the insurer about its premium and cover.

What you need to know

Section 28 (2) says dental treatment includes the dentist’s work to prevent, detect, and treat diseases of the teeth, mouth, and jaw, done sufficiently and appropriately, and it includes the conservative-surgical work and X-rays connected with replacement.

If you choose a filling beyond the comparable treatment, you pay the extra. The insurer settles the cheapest comparable filling placed and shaped directly in the tooth (plastische Füllung) as a benefit in kind. Before the higher-cost treatment begins, the dentist and insured patient must make a written agreement on the additional cost.

Section 55 is the fixed subsidy, the Festzuschuss, for medically necessary crowns and dentures and the related dental and technical work, when the method is recognised. Until 31 December 2026, the subsidy is 60 percent of the amounts set for standard care. It rises to 70 percent with regular dental care and the specified check-ups over the previous five years: the half-yearly examinations where section 22 applies, and at least one examination per calendar year after you turn 18. It rises to 75 percent with the corresponding ten-year record.

From 1 January 2027, the Act of 24 July 2026 sets those shares at 50 percent, 60 percent with the five-year record, and 65 percent with the ten-year record. The same check-up tests apply.

Missing a check-up in 2020 does not remove either bonus. In a justified exceptional case, the insurer can also accept one other gap in the ten-year record for the ten-year bonus, which is 75 percent before 2027 and 65 percent from 1 January 2027. Ask the insurer to assess a gap before assuming you have lost the bonus.

Under section 55 (2), a qualifying hardship covers standard care in full, adjusted to its actual cost and capped at the cost incurred. Until 31 December 2026 that is the ordinary 60 percent plus 40 percentage points. From 1 January 2027 the add-on is 50 percent of the standard-care amounts.

Recipients of Grundsicherungsgeld (Bürgergeld until 1 July 2026), BAföG, or assistance under Book XII meet the statutory hardship test, as do other cases section 55 (2) lists.

The same full cover applies when monthly gross receipts for living expenses do not exceed 40 percent of the monthly reference amount for one person. That share rises by 15 percentage points for the first relative living in the household and by 10 percentage points for each further relative of the insured person or of the life partner, and those relatives’ receipts count in the household total.

Just above that threshold, section 55 (3) applies a sliding scale: in addition to the base fixed subsidy, the fund can pay a further amount equal to the part of that base subsidy exceeding three times the amount by which monthly gross receipts exceed the income limit. The total contribution is capped at the full-hardship amount and the cost actually incurred.

If someone qualifying for full hardship chooses a restoration beyond standard care, the insurer’s contribution is limited to the standard-care amount, and they pay costs above it. A sliding-scale contribution can be lower.

A Festzuschuss approved before 1 January 2027 keeps the rates in force until 31 December 2026; that is the new section 55 (6). The percentages apply to the standard-care amounts, not to whatever a laboratory charges for a premium material.

If you choose care beyond the standard treatment, you pay the difference. The subsidy can still be paid towards a different kind of restoration, on the terms in subsections 4 and 5. Practices usually record check-ups in a bonus booklet; the law looks at the visits rather than the brand of booklet. Private insurance follows its contract, so check the premium and cover with your insurer.

What to do

1. Use a statutory dentist for treatment under section 28, and ask before a filling whether you are choosing the comparable filling placed and shaped directly in the tooth or paying extra. Agree any additional cost in writing with the dentist before the higher-cost treatment begins.
2. Keep the check-up record if you may need a crown or denture. The five-year record supports the higher five-year share and the ten-year record the higher ten-year share: 70 and 75 percent until 31 December 2026, and 60 and 65 percent from 1 January 2027. The 2020 exception, the insurer’s exceptional-case assessment, and the rule for approvals before 1 January 2027 still apply.
3. Ask for the free treatment and cost plan that section 87 (1a) requires before replacement work. Read which part is the Festzuschuss and which part is your payment. A higher laboratory fee does not increase the statutory percentage.
4. If your income is low, or close to the section 55 (2) threshold, ask the insurer to assess the hardship rule and the section 55 (3) sliding scale before you sign. A qualifying hardship covers standard care in full on the dated split above; choosing more expensive care leaves the excess for you to pay.

Have planned replacement work approved first

Section 87 (1a) requires the contract dentist to prepare a free treatment and cost plan before replacement treatment begins. The plan states the findings, the standard care, and the care actually planned, including its type, scope, and cost. The statutory fund checks the plan as a whole before treatment begins. Where the care is necessary, the fund grants the fixed subsidy under section 55 for the findings in the plan. Ask for that plan and the cost it sets out, and do not start planned replacement until the fund has checked it. Ask any supplementary insurer about its requirements too.

Before treatment, you can get a free second opinion from the patient-advice services of the dental chambers and the Kassenzahnärztliche Vereinigungen. KZBV’s patient-advice page is where that route is described. For planned replacement teeth, its second-opinion model uses the signed form Informationen zu Ihrem Zahnersatz and the paper copy the practice gave you. Ask that service which documents it needs. Keep the plan, the fund’s decision, any agreement to pay extra, and the final invoice.

A supplementary policy does not replace the subsidy

Section 55 is the statutory subsidy. It does not require a private dental contract. BaFin’s consumer brochure describes supplementary health insurance as a further private contract that can pay costs the statutory scheme does not pay. A dental contract of that kind pays only what the policy says. It does not change the 60, 70, and 75 percent shares until 31 December 2026, or the 50, 60, and 65 percent shares from 1 January 2027. Ask the fund which part is the Festzuschuss and ask the supplementary insurer which part, if any, the contract pays, including any waiting period the contract sets. This page states no private premium.

Common mistakes

• Believing every tooth-coloured upgrade is free. Section 28 says you pay the extra above the comparable filling.
• Assuming every missed check-up removes the bonus. Section 55 protects a missing 2020 visit and allows a justified exceptional case for the ten-year bonus.
• Using the 2027 shares for a subsidy the insurer approved before 1 January 2027. Section 55 (6) keeps the earlier rates for those approvals.
• Paying a private dentist and sending the invoice to the statutory insurer as if section 55 applied unchanged. Ask the insurer first.
• Treating a supplementary dental policy as a change to the statutory shares. Section 55 still sets the subsidy. The private contract pays only what it says.