Dental supplementary insurance for crowns

Statutory health insurance covers only a fraction of the cost of a dental crown, often less than 30 per cent. This can result in a significant financial burden of several hundred or even thousands of euros. Comprehensive dental supplementary insurance closes this gap and ensures you receive the best possible care without high out-of-pocket costs.

The dental crown cost trap: Why statutory health insurance only pays a fraction

A dental crown costs between €400 and over €1,000, depending on the material and the amount of work involved. Statutory health insurance (GKV) only contributes towards this with a benefit-based fixed subsidy. This covers 60 per cent of the costs for the so-called standard care – a medically adequate standard treatment.

For a molar, this means a simple metal crown without tooth-coloured veneering. If you want a more aesthetically pleasing all-ceramic crown for €1,000, the GKV subsidy remains at around €230. Your out-of-pocket contribution can therefore quickly exceed €770.

With a bonus booklet kept for over ten years, the subsidy increases to a maximum of 75 per cent of the standard care, which only marginally reduces the gap. The right dental supplementary insurance is therefore crucial to cushion these costs.

This is how supplementary insurance closes the coverage gap

A good dental supplementary insurance policy reimburses between 80 and 100 per cent of the remaining out-of-pocket costs, depending on the tariff. It covers the difference between the total costs and the prepayment made by statutory health insurance (GKV). This also applies to high-quality treatments that go beyond standard care, such as full ceramic crowns.

A calculation example illustrates the benefit:

• Total cost for a ceramic crown: EUR 1,000
• Fixed subsidy from GKV (60 per cent): approx. EUR 230
• Remaining out-of-pocket cost: EUR 770
• Reimbursement under a 90 per cent tariff: EUR 693

Your final out-of-pocket cost drops to just EUR 77 in this case. Many tariffs also cover other items such as functional analysis or special anaesthetic procedures. So the question is not whether you need dental supplementary insurance, but which one is the best fit.

Tariff comparison: These four criteria matter

When choosing the right policy, four factors are crucial for the later level of cover. A high percentage reimbursement alone is no guarantee of full coverage of costs. So pay close attention to the contract details to avoid pitfalls.

You should check these points:

• Reimbursement rate: Tariffs should cover at least 80, preferably 90 to 100 per cent of the costs of dental prosthetics.
• Benefit limits (dental scale): In the first few years, benefits are often capped at maximum amounts, for example €1,000 in the first year.
• Waiting periods: Many policies include a waiting period of up to eight months before benefits for dental prosthetics can be claimed.
• Schedule of fees for dentists (GOZ): The tariff should cover fees up to 3.5 times the GOZ rate, as practitioners may charge more for private services.

A thorough comparison of supplementary dental insurance policies is essential to find the cover that meets your needs.

Expert tips: Avoid pitfalls and maximise performance

Even with a premium tariff, there are hurdles that can reduce reimbursement. One of them is the medical examination when the contract is taken out. Treatments that have already been recommended or planned are usually excluded from insurance cover. That is why taking out the policy early is crucial.

Our expert tip: Always submit your dentist’s treatment and cost plan (HKP) to your supplementary insurance before treatment begins. This gives you a binding commitment regarding cost coverage and helps you avoid unpleasant surprises. This is especially important if you are wondering when the insurance will not pay.

Also make sure whether the dental benefits limit refers to the calendar year or the policy year. A calendar-year arrangement can be more advantageous if you take out the contract towards the end of the year. This means that after only a short time, you can already benefit from the higher reimbursement amount for the following year.

Conclusion: The right cover for a worry-free smile

The cost of a dental crown can hardly be offset by the statutory health insurance fixed allowance. A comprehensive dental insurance policy is the only way to significantly reduce your out-of-pocket costs and secure high-quality dental care. Plans that cover 90 to 100 per cent of the costs make even expensive all-ceramic crowns affordable.

The key is to choose a plan that not only offers a high reimbursement rate, but also fair conditions regarding dental scaling, waiting periods and billing in accordance with the GOZ. Taking out cover early, before a treatment case arises, is the key to your insurance's full benefits. This ensures that your smile does not become a cost trap.