Have you been putting off a visit to the dentist? You’re in good company: according to a 2018 study by the dental journal Die ZahnarztWoche, around 40% of Germans fail to get an annual dental cleaning.
True, the idea of having your gums poked and prodded isn’t particularly appealing. But for many people, the threat of sticker shock is greater than the fear of the dentist’s drill. And if you have public health insurance, it can be difficult to know what dental services are covered and what you might have to pay out of pocket.
So what will your insurer cover? And when do you need supplemental dental insurance?
What does public health insurance cover?
The Krankenkassen (public health funds) cover a number of 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. Supplemental dental insurance will usually cover these costs.
- Tooth replacement: If a tooth needs full or partial replacement, your Krankenkasse will pay a portion of the cost. In October 2020, the public insurance contribution for tooth replacements was increased from 50% to 60% of the total cost of a basic care-level (Grundvorsorge) treatment. Coverage can extend to 75% if you can prove you’ve been visiting the dentist regularly for preventive treatments. Supplemental dental insurance will usually cover the remainder of the cost. Again, if you opt for something more than “basic” (e.g. composite replacements instead of amalgam), then it makes sense to get dental insurance.
- 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). But please note 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.
Feather’s dental insurance offers up to 100% coverage for tooth cleanings, tooth replacements, whitening treatments, and more.
This article was originally posted on March 11, 2020, and was updated on October 7, 2020.