Public health insurance is a typical solidarity fund; participants pay according to their earnings. It is funded by the contributions of the insured individuals, their employers, and the government. Everyone enjoys the same coverage that is set by the government, and even though it is quite broad, it can be minimal sometimes. All the necessary treatments are covered, but aesthetics are not taken into account as much.

Since aesthetics can be an important aspect of dental procedures, let's see what you can expect to be covered by your public health provider in 2024.

Dental treatment comprises the activities of the dentist that are sufficient and appropriate for the prevention, early detection, and treatment of dental, oral, and maxillofacial diseases in accordance with the rules of dentistry. These are essentially the yearly checkups, removal of hard dental plaque ("tartar removal"), dental fillings, root canal treatment, oral surgery and periodontology services, and diseases of the oral mucosa. These services are generally free of charge for you.

There are exceptions for services that go beyond the scope of dental care contract and are freely chosen by the insured person within the framework of the so-called additional cost regulation (e.g., inlays). In this case, your dentist must make a written agreement with you before the treatment begins.

Public health insurance covers two dental check-ups per year. Your health insurance provider also rewards you for regular preventive behaviour by granting you a higher fixed allowance for dentures (more details under, where we talk about dentures).
Once per year, insurance will pay for tartar removal, i.e., the removal of hard dental plaque.

Every two years, health insurance companies cover the costs of early detection of periodontitis, the so-called periodontal screening index.

This is where public health insurance coverage lacks:

If you decide to go for the higher-quality composite filling or inlay, your public health provider will cover the costs in the amount of a comparable amalgam filling, and you will have to cover the rest. For reference, a composite filling will result in about €100 out of your pocket. The practice will invoice this amount directly via your health card.

The dentist will inform you of your co-payment. Before the treatment begins, you will make a written agreement on the additional costs.

Root canal treatment and the removal of root tips (resection) in the anterior and posterior regions are included in the scope of benefits provided by public health insurance, provided the affected tooth is classified as worth preserving. The cleaning, filling, and sealing of root canals are reimbursable services for root canal treatment.

A prerequisite for successful root canal treatment is that the root canal is measured precisely before the actual treatment. The standard method, which is paid for by the insurance companies, is to determine the length using X-ray images.

Dentures include fixed dentures (crowns, partial crowns, and bridges), removable dentures (partial dentures, full dentures, and interim dentures), and combined dentures (a combination of fixed and removable dentures).

In the case of medically necessary dentures, the statutory health insurance fund pays a fixed allowance. The amount of this is based on the dental findings and the usual treatment, the so-called standard treatment. Standard is the treatment that is suitable for the majority of cases. So simply put, public health insurers already have the pre-determined average prices of each standard treatment and will pay a fixed percentage of that. The rest will go out of your pocket.

The fixed allowance comprises 60% of the amount set for the respective standard treatment. If insured persons can prove that they have had a dental check-up in each of the five years prior to the start of treatment, the fixed allowance increases to 70% and, after ten years of uninterrupted use, to 75% of the costs of standard care. Dentists are obliged to provide their patients with a treatment and cost plan before treatment begins. Patients then submit the plan to their health insurance company for review and approval.
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​How do i prove I had a dental check-up each year? Until recently, you would get a little book from your dentist in which each check-up is marked. If you loose that one, no worries, your dentist has all the records and can issue a new one. In 2022, electronic bonus book was introduced, and most of the dentists now operate with it. So you can talk to your dentist and ask for it. It eases the process because everything is digital, and your dentist will automatically mark every check-up you did. That is shared with your public health insurance provider, so once the time comes to claim that allowance, everything is ready!

Back to the topic, let's take an example for a crown:

Average total costs for a standard treatment: €365.96

Public health insurance subsidy without bonus: 60% of the total cost of €219.58

Subsidy after 5 years of uninterrupted proof of preventive check-ups: 70% of the total costs = €256.17

Subsidy after 10 years of uninterrupted proof of preventive check-ups: 75% of the total costs = €274.47

Keep in mind that when we say standard treatment, it is mostly about the material used. So €365.96 will be the price of the cheapest, silver-coloured crown made of non-precious metal. This material will be used for the back teeth crowns, and insurance will also pay the fixed allowance for the partially veneered crown for the front teeth. If you would also like to have your teeth crowned with high-quality material in a non-visible area, you will have to bear the costs yourself.

So, for example, a fully ceramic crown will cost between €700-1000 or more, and your public health provider will still only pay the percentage of the standard amount stated above (around €250). Meaning, you will have to pay the bigger part out of your pocket, starting at around €500.

You can apply for a higher fixed allowance for dentures if your monthly (family) gross income does not exceed the following amounts in 2024:

For a single person: €1,414

With one relative: €1,944.25

An additional €353.50 for each additional relative

In most cases, that means that the public provider will cover 100% of the standard treatment you have undertaken.

The correction of misaligned jaws or teeth, for example, with braces, is covered for medically justified indications up to the age of 18.

Dentists recommend doing prophylaxis at least once per year. It averagely costs from €100–150 per procedure and most of the public health providers only provide a fixed yearly budget of €40–60 for it. Therefore, once again, a larger part of the cost will have to go out of your pocket.

Taking into account all the extra costs you might face in case you wish to get a "better-than-standard" treatment, looking into our additional dental insurance will likely be worth it!