What dental prostheses cost – and what health insurance covers
The fixed allowance depends on the findings, not on what you choose.
Dental prostheses are the area of dentistry with the greatest price differences – and with the greatest uncertainty on the patient's side. That is down to the system: statutory health insurance pays no share of your bill, but a fixed amount per finding. Anything beyond that you pay yourself.
How the fixed allowance works
For every finding – a missing tooth here, three there – a standard care is laid down: the restoration that is medically adequate. The insurer covers 60 per cent of the costs set for it. With a maintained bonus booklet that becomes 70 or 75 per cent. This amount is fixed, regardless of whether you choose the standard care or something more elaborate.
Of the same kind and of a different kind
If you choose the same form of restoration, only better executed – for example a full ceramic crown instead of a metal crown – that is called of the same kind: you receive the fixed allowance and pay the difference. If you choose an entirely different form – for example an implant instead of a bridge – that is called of a different kind: you receive the same fixed allowance, but the practice invoices privately.
Rough points of reference
A metal crown is in the mid three-figure range, a full ceramic crown well above that. A three-unit bridge is in the four-figure range, a telescopic denture considerably higher depending on the number of abutments. Exact figures come only from the treatment and cost plan – any figure without findings is guesswork.
If it would not be enough
For insured people on a low income there is the hardship rule: then the insurer covers the standard care in full. Nobody has to plead for that, it is an entitlement.
The most important points at a glance
- The insurer pays a fixed allowance per finding, not a share of your bill.
- With five years of an unbroken bonus booklet it rises from 60 to 70 per cent, after ten years to 75.
- Of the same kind means: the same form, better execution – you pay the difference.
- Of a different kind means: a different form – you receive the same allowance, the bill is private.
- With a low income the insurer covers the standard care in full.
Answered briefly
Frequently asked questions
Each finding has a standard care assigned to it. The insurer covers 60 per cent of the cost set for that, 70 or 75 per cent with a maintained bonus booklet.
The same form of restoration, only carried out more elaborately – for example full ceramic instead of metal. You receive the fixed allowance and pay the difference.
A different form of restoration from the standard care – for example an implant instead of a bridge. You receive the same fixed allowance; the practice invoices the rest privately.
Six months from approval. If the treatment starts later, a new application is needed.
On a low income the insurer covers the standard care in full. The application goes to the insurer together with the treatment and cost plan, before the treatment begins.
Only if it is taken out while the teeth are in good order. If the cost plan already exists, the finding is as a rule excluded.
Many practices agree to instalments, often without interest. That is usually the cheapest option – ask there first.