What a brace costs – and what statutory health insurance covers
The decisive question is not the price but the classification. It determines who pays.
For children and adolescents, statutory health insurance pays for orthodontic treatment – if the malocclusion is pronounced enough. Whether that is the case is decided not by appearance but by a classification: the German orthodontic indication groups, KIG for short.
The KIG classification
The orthodontist measures the findings and assigns them to one of five grades. From grade 3 onwards, statutory health insurance covers the treatment. Grades 1 and 2 count as mild malocclusions; they have to be paid for privately. The classification is not negotiable and is submitted to the insurer together with the treatment plan.
The co-payment that is not one
Even when costs are covered, parents initially pay 20 percent of the costs themselves – 10 percent for a second child in treatment. This amount is refunded in full after successful completion. Anyone who breaks off the treatment does not get it back. Keep the receipts.
What remains private
Alongside the standard care, practices offer additional services: ceramic instead of metal brackets, aligners instead of a fixed brace, brackets bonded on the inside, special archwires. They are not medically necessary and therefore have to be paid for privately. They belong in a written additional-cost agreement before treatment begins – not on an invoice at the end.
Adults
From the 18th birthday, statutory health insurance no longer pays. The exception is severe jaw misalignments that have to be treated orthodontically and surgically together.
Source: directives of the Federal Joint Committee (Gemeinsamer Bundesausschuss) on orthodontic treatment.
The key facts at a glance
- Statutory health insurance pays for children and adolescents from KIG grade 3. Grades 1 and 2 have to be paid for privately.
- The co-payment of 20 percent – 10 for a second child – is refunded in full after successful completion. Keep the receipts.
- Additional services such as ceramic brackets or aligners are private. They belong in a written additional-cost agreement beforehand.
- From 18, statutory insurance no longer pays – except for severe jaw misalignments requiring surgery.
Answered briefly
Frequently asked questions
If the statutory health insurance covers the treatment, you initially pay the co-payment of 20 percent and get it back after successful completion. Without coverage, or for adults, the amount depends on the scope: the number of teeth to be moved, the duration, the type of appliance. The figure only becomes reliable with the written treatment and cost plan.
Kieferorthopädische Indikationsgruppen – the German orthodontic indication groups. The orthodontist measures the findings and assigns them to one of five grades. From grade 3 upwards, statutory health insurance covers the treatment. The classification is tied to measurable values, such as the overbite in millimetres.
Yes, in full once the treatment has been successfully completed. If the treatment is discontinued or ends without a final report, there is no refund. Submit the receipts to your health insurance after completion.
Only if it was taken out before the diagnosis. Almost all policies exclude treatments that have already been recommended or are under way. Anyone who takes out the insurance only after the orthodontist has recommended a brace pays premiums without receiving benefits.