Short for DTF by abbreviationfinder, dental treatment or even dentures can cause enormous costs. Statutory health insurances (GKV) do not always or only partially pay for dental or orthodontic treatments.
- Statutory health insurance provides for a so-called fixed allowance for dentures, which covers 50 percent of the costs of the prescribed “economic” measures.
- The alternative to standard health insurance is supplementary dental insurance or dental prosthesis insurance. But the exact services vary greatly depending on the provider.
- Supplementary dental insurance is an area of supplementary health insurance. In addition to the “tooth” area, this additional insurance can also be taken out in the hospital or for alternative practitioner treatments.
Statutory health insurance benefits for dental treatment
The statutory health insurance funds take over, according to § 12 SGB V services that are “sufficient, appropriate and economical” and considers “what is necessary not exceed”. This means that, for example, dental treatment that serves purely aesthetic purposes – such as tooth whitening – is not part of the standard care and cannot be taken over. Only dental treatments that serve to restore health – for example, for tooth decay , root or tartar problems – are paid for by the statutory health insurance.
In addition, only the cheapest reasonable dental treatment is always paid for. For example, in the case of tooth decay, statutory health insurances only pay for the relatively inexpensive amalgam filling – and not for a ceramic filling , which would be of significantly better quality. The cost of a composite filling will only be covered if there is a proven allergy to the amalgam filling or if the front teeth are visible . Anyone who nevertheless decides on dental treatment with ceramic filling must bear the cost difference on their own responsibility.
Statutory health insurance benefits for dentures
Statutory health insurance provides for a so-called fixed allowance for dentures, which covers 50 percent of the costs of the prescribed “economic” measures. The same applies here: If you choose a higher quality and more expensive one instead of the prescribed denture measure, the same low amount will still be reimbursed. You have to pay the rest out of your own pocket. If the legally insured person’s teeth show a sufficient level of personal efforts to care for their teeth and if, according to the bonus booklet, they have regularly performed dental check-ups, the fixed allowance is increased by a few percentage points: for five years by 20 percent, for ten years by 30 percent. A maximum of 80 percent fixed subsidy is therefore possible.
Subsidy for hardship cases
In cases of hardship, the fixed allowance is increased by 100 percent. According to the current legal situation, these hardship cases include all those who, as a single person, do not earn more than 40 percent of the gross monthly reference figure. In 2017, the reference value for old federal states was 2,975 euros and for new ones at 2,660 euros. If the household consists of two people, the earnings can be up to 55 percent of the reference figure. For every other relative living in the household, the limit rises by a further 10 percent. Nevertheless, the subsidy relates to the cheapest option and not to the actual cost of the denture.
Obligation to provide information about the cost of treatment
Often times, doctors recommend good, but expensive, treatments to their patients. However, according to Section 630c of the German Civil Code (BGB), they have a so-called duty to inform: In addition to the diagnosis, possible side effects and the like, all patients must also be informed about the costs that they are likely to have to bear. Nevertheless, health insurers are always well advised to ask the dentist in detail about the costs and alternative options before starting treatment. It may also be worthwhile for patients to visit multiple dentists. Because even if there is a binding fee schedule for dentists (GOZ), it can be interpreted differently.
The benefits of dental prosthesis insurance
The alternative to standard health insurance is supplementary dental insurance or dental prosthesis insurance . But the exact services vary greatly depending on the provider. Most insurers pay for normal dentures – that is, for crowns , bridges, prostheses, post teeth and implants. Some also cover the cost of ceramic or gold inlays. Relatively few insurances cover pure dental treatment such as professional teeth cleaning . Furthermore, the individual insurances differ in terms of the extent to which or whether they cover orthodontic treatments at all.
There are also other limitations to the benefits of the additional dental insurance, which differ depending on the insurance. Some pay less in the first few years after signing the contract, others take on the same sums in the first few years as years later. In addition, the waiting times should be taken into account, during which no costs are paid. For most providers, these are eight months. The reason for this is that the insurance companies want to protect themselves against patients taking out additional dental insurance only after determining the necessary treatment.
Take out additional insurance for existing dental problems
Even if there are already defects in the dentition, you can take out additional dental insurance. Supplementary dental insurance is an area of supplementary health insurance. In addition to the “tooth” area, this additional insurance can also be taken out in the hospital or for alternative practitioner treatments. If the dentist advises a certain dental treatment or even dentures before the start of the insurance, the insurance will not pay for it. Only a dental treatment that is prescribed or advised after the waiting period will be covered.
Tooth gap and dentures
If you already have missing teeth, the gaps between the teeth can be insured with some insurance companies – but only if the insured event has not yet occurred. This means that if you have had a tooth gap for several years and the doctor has not yet recommended dental treatment or dentures, the gap can be included in the dental prosthesis insurance. If a dental prosthesis is advised later, this will also be taken over. In the event that a dental prosthesis was already planned, however, the gap cannot be included in the insurance.
Periodontal disease
In most cases, if a person has periodontal disease, they will not be able to take out insurance until everything has returned to normal. However, there are also insurance companies that do not ask about previous illnesses. Here you can also take out insurance for periodontal disease. The insurance cover then does not apply to the current and planned dental treatments against periodontal disease.
Comparison of tariffs
When you have decided on additional dental insurance, you should compare the various insurances, as there are big differences. You should pay particular attention to your own needs, as, for example, some insurance companies pay more for certain dental treatments, while others offer better dental prosthesis services.
