Dental supplementary insurance: benefits, fixed subsidy and your own share of the cost

The statutory health insurance fund pays a fixed subsidy for dentures, based on the diagnosis, of 60 percent of the standard care rate — up to 75 percent with a bonus booklet. Everything above that, such as a full ceramic crown, is your own share of the cost. Here you can read how the fixed subsidy, standard care and your own share interact, and which part of your bill is insurable at all.

How the insurance fund calculates: fixed subsidy and standard care

The statutory health insurance fund pays a fixed subsidy for dentures, based on the diagnosis, amounting to 60 percent of the average costs of standard care (§ 55 SGB V) — never a percentage of your actual bill. That is the crucial point: the subsidy is based on the standard therapy for your diagnosis, not on the treatment your dentist proposes. If you choose a higher-quality solution, your own share grows while the subsidy stays the same.

How the system works: before any denture treatment, your dentist determines the dental diagnosis — for example, tooth substance requiring a crown or a single-tooth gap. For each of these diagnoses, the Gemeinsamer Bundesausschuss (G-BA) defines which treatment constitutes standard care and which average costs are assumed for it; this is adjusted annually.^[1] The catalogue of the fixed subsidy directive covers more than 50 individual diagnoses, each with its own fixed subsidy amount.^[2]

Standard care is the treatment that constitutes the standard therapy for the given diagnosis: according to the Social Code, it must be sufficient, appropriate and economical.^[2] For a crown in the posterior tooth area, for example, this is a metallic full crown without veneering; for a single-tooth gap, a bridge. These benefits are scientifically validated and have endured because they work well. However, they are deliberately defined as the most cost-effective solution.

Your freedom of choice does not change the statutory benefit. You may choose any scientifically recognised treatment option, for example an all-ceramic bridge instead of the metallic standard care or an implant instead of a bridge. The fixed subsidy is never lost, but it remains exactly the same amount. You cover the difference between the total cost of your preferred solution and the fixed subsidy as your own share.^[1]

This is exactly the gap that supplementary dental insurance closes: it kicks in where the fixed subsidy ends and reimburses an agreed share of the costs that go beyond standard care. How high your own share is in a given case depends on three factors: your bonus booklet, the treatment you choose, and the reimbursement basis of your policy. The next sections go through the three factors one by one.

Bonus booklet and hardship cases: when the subsidy increases

The fixed subsidy of 60 percent is the lower limit. With a fully documented bonus booklet, in which your dental check-ups are recorded, the subsidy rises to 70 percent after five years and to 75 percent after ten years (§ 55 SGB V).^[2] For a crown, that means as of 1 January 2026: 239.03 euros without a bonus, 278.87 euros after five years, and 298.79 euros with a ten-year bonus booklet.^[1]

• Without a bonus booklet: fixed subsidy of 60 percent of standard care.
• Bonus booklet kept without gaps for five years: 70 percent.
• Bonus booklet kept without gaps for ten years: 75 percent.
• Exception, hardship rule (only for low incomes): instead of 60 to 75 percent, the health fund covers the costs of standard care in full, i.e.^[1] 100 percent of those costs, not 100 percent of your invoice.

A single lapse does not have to cost you your ten-year bonus level. According to a ruling by the Federal Social Court (Bundessozialgericht) of 28 May 2026 (case no. B 1 KR 22/25 R), a single missed examination year within the ten-year period can remain without consequence if you give the health fund sufficient reasons why the appointment was not possible. The bonus year 2020 counts as fulfilled for all members of statutory health insurance anyway due to the coronavirus pandemic.^[3][1]

For those on low incomes, the hardship rule applies: if you choose standard care in this case, the health fund covers its costs in full. In 2026 the income threshold is 1,582 euros in gross monthly income for single people and 2,175.25 euros with one dependant, with a further 395.50 euros added for each additional dependant.^[1] Even above these thresholds, the so-called sliding hardship rule can bring an increased subsidy, so it can be worth asking your health fund with proof of income.^[4]

Important for context: even in a hardship case, the subsidy applies only to standard care. If you choose a higher-quality solution, the subsidy remains limited to the costs of standard care — 398.39 euros for a crown — and you pay the additional costs on top yourself.^[1] Keeping a bonus booklet is still worthwhile for everyone: it is the only free increase the system offers.

Worked example: a crown — how your own share adds up

A concrete example shows how the fixed subsidy, standard care and your own share relate. For a full metallic crown in the posterior tooth region, a total of 398.39 euros is assessed in 2026 — that is the standard care for this finding.^[2] The health fund pays 239.03 euros of that without a bonus booklet, or 298.79 euros with a ten-year bonus booklet.^[1] Your own share for the standard crown alone is therefore around 99 to 159 euros depending on your bonus level.^[5]

Things change if you want a higher-quality crown. A full ceramic crown costs around 600 to 900 euros in 2026, depending on the effort involved and the region.^[5] The fixed subsidy is unaffected by this: it continues to be based on the metallic standard care, i.e. 239.03 euros without a bonus or 298.79 euros with a ten-year bonus record. Your own share is calculated as total costs minus the fixed subsidy.

The calculation reveals the core problem of the fixed subsidy system: the subsidy stays the same, no matter which type of care you choose. You alone bear the additional costs of the higher-quality solution. With a full ceramic crown, that amounts to several hundred euros in 2026 – per crown. With a bridge with several crowns or implant treatment, this amount multiplies accordingly. It is precisely this share of the additional costs that is the part of your bill that a dental supplementary insurance can cover.

The three coverage areas of a dental supplementary insurance

A dental supplementary insurance reimburses in three areas, and each area has its own reimbursement rate in the tariff. This is important to know, because a tariff with 100 percent reimbursement for dentures can be significantly lower for dental treatment – and vice versa. The three areas at a glance:

• Dentures: crowns, bridges, inlays, implants and dentures. This is the area where the fixed subsidy gap is largest and where the reimbursement rates of the tariffs vary the most.
• Dental treatment including prophylaxis: plastic fillings, root canal treatments, periodontitis treatments and professional dental cleaning, which those with statutory insurance usually have to pay for entirely themselves. Some tariffs reimburse 100 percent of the bill here, often with maximum amounts per measure and calendar year.
• Orthodontics: braces and aligner therapies, often with their own benefit limits in the tariff and sometimes only for certain severity levels of jaw misalignment.

To put the areas into context: dental treatment covers everything your dentist treats on existing teeth, while dentures replace missing or severely damaged teeth. Orthodontics is a separate area because it often runs over several years and therefore needs its own benefit limits. Which area is relevant for you depends on your situation: if you are facing denture treatment, you mainly need the first area; if you go for prophylaxis regularly, you benefit from the second.

These three areas are also the yardstick against which you should read every tariff: check for each area individually what percentage is reimbursed, what basis the reimbursement refers to and what maximum amounts apply. A tariff that is only strong in one area will hardly help you if your upcoming treatment falls into another.

What is insurable at all: reimbursement basis and limits

Not the entire bill is automatically insurable, and the reimbursement basis determines how much is actually reimbursed in the end. It refers to the amount on which your tariff's reimbursement rate is based. Good tariffs apply the benefit to the private bill amount, i.e. your full bill according to the fee schedule for dentists (GOZ).^[6] Weaker tariffs only refer to the part that the health insurance fund subsidises, i.e. the standard care – then even a high percentage reimburses you only a fraction of your actual costs.

The quality of a tariff is therefore shown by two figures together: the reimbursement basis and the reimbursement rate. High-quality tariffs reimburse 80 to 95 percent of the bill amount, some are at 100 percent.^[6] The order matters: first, the health insurance fund settles its fixed subsidy directly with the practice, after which the tariff reimbursement refers to the amount that remains as your own share on your bill. With a full ceramic crown at the upper end of the price range, i.e.^[5] total costs of around 900 euros, around 660 euros of your own share remain without a bonus record, of which a good tariff covers the vast majority.

On top of that come limits that every tariff sets differently. Omitting them would be the mistake that hits you hardest, because they determine what is actually reimbursed in the first few years:^[6]

• Dental scale (Zahnstaffel): a cap on reimbursement during the first three to five insurance years at maximum amounts that rise from year to year and only disappear entirely after that.
• Maximum amounts per benefit: for example, for professional teeth cleaning, often with a fixed upper limit per calendar year.
• Exclusion of ongoing treatments: treatments already recommended or started are excluded in most tariffs or only insurable at an extra premium.
• Limits on material and laboratory costs: some tariffs cap exactly the part of the bill that makes up the largest share with high-quality dentures.

Does that apply to you? Supplementary dental insurance is worthwhile above all when two conditions come together: you want to keep the option of high-quality dentures open, such as full ceramic instead of metal, and your teeth are currently free of any treatment recommendation, so that no ongoing treatment blocks the conclusion. If standard care is enough for you, you usually pay more for the policy than it brings you.^[6] Which tariff fits your situation is something a general article cannot answer: what matters are the reimbursement rate, the reimbursement basis and the limits of the first insurance years.

Outlook and next steps

Today's status: the fixed subsidy covers 60 percent of standard care, up to 75 percent with a bonus booklet, and is based solely on the diagnosis, never on your bill. The fixed subsidy amounts are re-set annually, most recently by resolution of the Gemeinsamer Bundesausschuss of 5 December 2025, effective 1 January 2026. How the amounts will develop in the future and whether tariff conditions will change cannot be reliably predicted from today's vantage point – tariffs and statutory rules are constantly adapting.^[7]

So the general rule is: the statutory health insurer only contributes to the standard therapy for your diagnosis. The distinction that decides your case is the question of whether you are satisfied with this standard therapy or whether you want high-quality dentures – in the latter case you bear the extra costs yourself, and that is exactly what supplementary dental insurance is for. Whether and to what extent taking out a policy pays off for you depends on the condition of your teeth, your bonus booklet and your expectations. A general article cannot resolve this individual case.

As a next step, you can use nextsure's supplementary dental insurance service: nextsure compares tariffs transparently, advises you independently and handles the contract conclusion fully digitally. In a personal consultation, you can clarify which tariff fits your dental situation and what reimbursement you can expect for a planned treatment.