Dental Restorations: What Does Statutory Health Insurance Cover in 2026?

The German statutory health insurance system uses finding-related fixed subsidies for dental restorations.

The first step is to establish the dental situation present in the individual patient.

Examples of such findings may include:

• a severely damaged tooth requiring a crown,
• a gap caused by a missing tooth,
• several missing teeth,
• or an existing dental restoration that needs to be renewed or repaired.

The fixed-subsidy guideline assigns a standard treatment to the relevant finding.

The amount paid by statutory health insurance is then determined by this finding — not by how expensive the treatment ultimately selected by the patient is.

Regelversorgung is the standard treatment defined by the German Federal Joint Committee (G-BA) for a specific finding within statutory health insurance.

It is intended to provide adequate, appropriate and cost-effective care.

Importantly:

Standard care does not mean that every patient must choose exactly this treatment.

It is, however, the basis used to calculate the fixed subsidy.

Patients who choose a different or more extensive treatment can generally retain the finding-related fixed subsidy. Depending on the type of treatment selected, however, they must pay the additional costs themselves.

This common wording is too imprecise.

The correct formulation is:

The basic fixed subsidy generally corresponds to 60% of the amount assigned to the standard treatment for the diagnosed finding.

That is different from 60% of the actual invoice.

A simplified example:

Suppose a particular finding has a defined standard treatment. The fixed subsidy is calculated from that standard treatment.

If the patient instead chooses a treatment with additional or different services, the subsidy does not automatically rise in proportion to the higher total price.

The additional cost may therefore remain partly or entirely payable by the patient.

Regular preventive dental examinations can increase the fixed subsidy.

According to the position applicable in 2026, the general rule for adults is:

• without the relevant bonus documentation: 60%,
• with five years of appropriately documented regular preventive examinations: 70%,
• with ten years of appropriately documented regular preventive examinations: 75%,

in each case calculated on the amount applicable to the standard treatment.

The bonus record, or corresponding proof of preventive attendance, is therefore financially relevant.

A patient with a gap in the documentation should not automatically assume that the bonus has been lost permanently. The KZBV points to current legal provisions that may apply to individual justified missed examinations. Whether an exception is accepted should be clarified with the relevant health insurer.

A hardship provision exists for people insured under the statutory system who meet the relevant financial criteria.

If the requirements are fulfilled, the statutory insurer can increase the subsidy for standard care so that the medically necessary standard treatment can be fully covered within the statutory limits.

This does not mean:

“Any dental restoration is free in a hardship case.”

A patient who chooses a treatment that goes beyond standard care may still have to pay additional costs even when the hardship rule applies.

Because income thresholds and personal eligibility are assessed under the applicable statutory and insurance rules, this page deliberately does not promise that any individual patient qualifies for hardship assistance.

The patient's own health insurance provider can make the binding eligibility assessment.

Before planned dental-restoration treatment, a treatment and cost plan ( Heil- und Kostenplan , HKP) is prepared.

It documents, among other things:

• the dental findings,
• the applicable standard treatment,
• the treatment that is actually planned,
• and the expected costs.

For patients insured under statutory health insurance, the relevant data are now transmitted electronically to the insurer.

The insurer reviews the application and determines the approved fixed subsidy.

This step is important because it shows which subsidy has been assigned to the patient's specific dental finding.

In the regular statutory health insurance process, the treatment and cost plan is submitted to the insurer before treatment and the fixed subsidy is determined.

The planned treatment route, including the insurer's decision, should therefore generally be clarified before definitive dental-restoration treatment begins.

Special urgent medical situations may differ.

For normal planned treatment, however, it is useful to know the financial and insurance basis clearly in advance.

A treatment is described as gleichartig when it generally follows the type of standard care but includes additional services or a higher-specification execution.

In simplified terms:

The basic principle of the standard treatment is retained, but expanded.

The insurer continues to pay the finding-related fixed subsidy.

The insured person pays the additional costs above the standard treatment.

Whether a particular restoration is classified as standard, equivalent or alternative care depends on the actual treatment plan and the underlying finding.

An andersartige Versorgung is a fundamentally different treatment type from the standard treatment defined for the finding.

A typical situation may arise when the standard treatment would be a conventional prosthetic solution but the patient chooses a fundamentally different form of restoration.

The approved finding-related fixed subsidy can generally still remain available.

The patient pays the additional cost of the alternative treatment in accordance with the applicable billing rules.

The subsidy therefore continues to follow the finding, not the price of the preferred treatment.

Because two treatments with very different total costs can start with the same finding-related subsidy.

The fixed-subsidy system answers the question:

“What finding is present, and what standard treatment is defined for that finding?”

It does not directly answer:

“What percentage of the treatment I personally want will my insurer pay?”

This is where many misunderstandings arise with crowns, bridges and particularly implant-supported restorations.

That depends on the finding and the standard treatment defined for that finding.

The subsidy is not calculated simply according to the specific crown material selected by the patient.

If a higher-specification execution or additional service is chosen, this may result in a patient contribution above the fixed subsidy.

Giving a specific euro amount without an examination and treatment and cost plan would therefore be unreliable.

More about dental restorations

Again, the finding is decisive.

For a tooth gap, the standard treatment defined by the current guidelines for that specific finding is identified.

If the patient chooses a different or more extensive treatment, the finding-related subsidy generally remains the starting point while additional costs may need to be paid privately.

Material, design, number of abutment teeth and the individual oral situation can all significantly influence the total cost.

The answer requires an important distinction.

An implant treatment consists of more than the visible final tooth replacement. It can include the implant body, surgical procedures, abutment components and the prosthetic restoration.

Under statutory health insurance, implants themselves are generally not part of routine standard care. The finding-related fixed subsidy is usually linked to the prosthetic situation that would otherwise be treated by the corresponding standard care.

If a patient chooses an implant-supported solution instead, the fixed subsidy for the underlying dental-restoration finding can remain relevant, while implant-related and additional private costs may remain payable by the patient.

It is therefore misleading to say simply that statutory health insurance “pays 60%, 70% or 75% of an implant”.

More about dental implants

There are narrowly defined exceptional situations in which implant-related treatment may be considered within statutory health insurance under the applicable rules.

These are not the normal situation for routine tooth replacement and cannot be inferred from the mere fact that an implant is medically desirable or preferred.

Whether a statutory exception applies requires assessment of the specific medical and insurance circumstances.

Patients who believe such an exceptional indication may be relevant should clarify this with their dentist and statutory health insurer before treatment.

Digital manufacturing or a particular high-quality restorative material does not automatically change the finding-based fixed subsidy.

At the practice, suitable restorations can be planned digitally and, in certain situations, manufactured using the available CAD/CAM workflow.

For the question of cost, however, the following remain decisive:

• which clinical finding is present,
• which standard care is assigned to that finding,
• which restoration is actually planned,
• and which additional services arise.

CEREC is therefore a manufacturing workflow — not a separate statutory health insurance subsidy.

More about CEREC and CAD/CAM

The patient's own contribution can depend on several factors:

• the dental finding,
• the chosen type of treatment,
• material,
• number of teeth treated,
• dental laboratory requirements,
• additional private services,
• bonus entitlement,
• possible hardship assistance,
• and the individual insurance situation.

General tables stating that “a crown always costs X” or “an implant always costs Y” are therefore of limited value.

Two patients with apparently similar gaps can have different findings, prerequisites and treatment plans.

The most useful basis is the individual treatment and cost plan.

It should make clear:

1. which finding has been diagnosed,
2. which standard treatment is assigned to that finding,
3. which treatment is actually planned,
4. the expected fixed subsidy,
5. the additional costs,
6. and the resulting expected patient contribution.

If anything is unclear, it should be discussed before treatment begins.

Patients can obtain a second dental opinion before extensive restorative treatment.

The final total alone should not, however, be the only point of comparison.

It is important to establish whether the plans actually refer to the same medical treatment.

Different materials, laboratory services or treatment concepts can produce different prices even when two plans appear similar at first glance.

A meaningful comparison therefore requires both medical and financial comparability.

Depending on the policy, private supplementary dental insurance may cover additional costs.

How much is actually reimbursed depends on the specific policy terms.

Relevant factors may include:

• contractual reimbursement limits,
• waiting periods,
• teeth that were already missing when the policy started,
• staged benefit limits,
• definitions of specific materials or treatment types,
• and treatment that had already started or been recommended before cover began.

A dental practice can provide an expected treatment and cost plan.

The binding decision on benefits under a private supplementary policy is made by the insurer.

No, not in the same form.

This page primarily explains the German statutory health insurance (GKV) system.

For private health insurance, reimbursement depends on the patient's individual tariff and insurance contract.

Civil-service assistance schemes and supplementary insurance policies also have their own rules.

Privately insured patients should therefore have the specific treatment and cost plan checked against their own contractual conditions.

Before a larger treatment, useful questions include:

• What exactly is my dental finding?
• What would the standard treatment be for this finding?
• Which treatment is actually being recommended to me?
• Is it standard care, an equivalent type of treatment or an alternative type of treatment?
• What fixed subsidy has been approved?
• Which services do I need to pay for myself?
• What medically reasonable alternatives are available?
• What later costs may arise for maintenance, repair or replacement?
• Has my bonus entitlement been taken into account?
• Should I ask whether I qualify under the hardship rule?

These questions make the treatment and cost plan easier to use as a genuine decision-making tool.

German statutory health insurance pays a finding-related fixed subsidy for dental restorations — not simply a percentage of the patient's actual invoice.

For 2026, the general levels are:

• 60% of the standard-care amount applicable to the finding without a bonus,
• 70% with appropriately documented preventive attendance over five years,
• 75% with appropriately documented preventive attendance over ten years.

There is also a hardship provision for eligible insured patients.

Important points are:

• Standard care is the basis for calculating the subsidy.
• Choosing a higher-specification treatment does not automatically increase the fixed subsidy.
• With equivalent or alternative types of dental restoration, additional costs can remain payable by the patient.
• For implants, the subsidy relates to the underlying dental-restoration finding and not as a blanket percentage of the entire implant invoice.
• The specific euro amount is determined only after the findings and treatment and cost plan are available.
• Private health insurance follows its own tariff and contractual rules.

Further information:

Dental restorations at the practice Dental implants CEREC and CAD/CAM

The information about the statutory fixed-subsidy system was checked immediately before publication against information from the National Association of Statutory Health Insurance Dentists (KZBV) and the German Federal Joint Committee (G-BA).

The currently applicable fixed-subsidy guideline took effect on 1 January 2026. The fixed-subsidy amounts were adjusted for 2026.

The figures of 60%, 70% and 75% relate to the amount defined for the relevant standard treatment and must not be confused with percentage reimbursement of any treatment chosen by the patient.

Editorial review date: 10 August 2026. The patient's individual findings, treatment and cost plan and the decision of the relevant health insurer determine the actual patient contribution.

Fixed subsidies for dental restorations in 2026 explained clearly: standard care, bonus record, treatment and cost plan, hardship rules, and equivalent or alternative types of restoration.