Popsure customers often ask if their public health fund covers dental care. Generally, public insurance covers preventive and “medically necessary” dental work—but for many procedures, you’ll have to pay for at least a part of your treatment.
So what’s covered? And do you need supplemental dental insurance?
What does public health insurance cover?
The Krankenkassen (public health funds) are required to cover a number of preventive procedures. These include:
- Annual dental screening: Your dentist will check your mouth for signs of gum disease, tooth breakage, or cavities. Depending on the Krankenkasse, this may be covered once or twice a year. (Get two free screenings a year with TK.)
- Gum disease treatments (Parodontosebehandlung): If your dentist finds signs of gum disease, your health fund will pay for treatment, including additional dental appointments. But if your dentist recommends more advanced treatment methods (e.g. laser therapy), those probably won’t be covered.
- Fillings: Your public health provider will cover the costs of cavity removal and fillings—under certain conditions. Most providers will only cover certain types of fillings. Many public providers, for example, cover more expensive composite fillings for visible front teeth, but will only pay for cheaper (and less cosmetically pleasing) amalgam fillings for back teeth. If you choose to get composite fillings in your back teeth, you’ll need to pay the difference.
- Root canals: If you need a root canal, your Krankenkasse will cover the costs under certain conditions. (Generally, the tooth needs to be deemed “worth saving.”) Otherwise, you’ll need to cover part or all of the costs yourself.
- Wisdom tooth extraction: The public health funds will cover “medically necessary” extraction (e.g. in cases of impacted or infected teeth). It’s worth noting that they only cover local anaesthetic—so if you’re looking for general anaesthesia or laughing gas to take the pain away, you’ll have to pay extra.
What about a standard cleaning?
The public health funds cover plaque removal (Zahnsteinentfernung) once a year as part of preventive coverage. However, the health funds will not cover a more intensive cleaning, which includes polishing the teeth and administering a fluoride treatment. If you want the full cleaning, you’ll have to pay out of pocket.
Supplemental dental insurance
A supplemental dental insurance policy will cover a large portion of the costs that the Krankenkassen don’t cover. Supplemental policies will provide full or partial coverage for more cost-intensive procedures like root canals, implants, and tooth replacement, and are more likely to cover cleanings. Whether or not you’ll benefit from supplemental insurance depends largely on your personal situation and prior oral health—but it can be a good safeguard against sticker shock for unexpected dental work.