Dental, prescriptions and what's not fully covered

Germany's public health insurance system, known as the Gesetzliche Krankenversicherung or GKV, provides solid coverage for essential healthcare. However, many costs that matter to you—especially dental work, premium prescription options, and specialist treatments—require either co-payments or supplementary insurance. Understanding what GKV covers and what it doesn't will help you plan ahead and avoid unexpected bills.

Prescription Co-Payments: The Zuzahlung

When you pick up a prescription at a German Apotheke (pharmacy), you will likely need to pay a co-payment called a Zuzahlung. This is a standard part of how GKV shares costs with insured patients. The rules are simple but important to understand so you aren't caught off guard at the checkout.

How Much You Pay

For each prescribed medication on a standard GKV prescription (called a Kassenrezept), you pay 10 percent of the retail price of the drug, with a minimum of €5 and a maximum of €10 per package. This means that for most medications, your actual out-of-pocket cost will fall somewhere in that €5–€10 range. Even if a medicine costs €100, you pay only €10. Children under 18 are fully exempt from prescription co-payments.

Annual Cost Cap

Germany caps your total annual prescription co-payments at 2 percent of your household gross income. If you have a chronic illness, that cap drops to 1 percent. Once you reach this threshold, you can apply to your health insurance fund (Krankenkasse) for a Zuzahlungsbefreiung—a co-payment exemption certificate. After receiving this document, you no longer pay co-payments for the rest of that calendar year. This protects people with ongoing medication needs from paying indefinitely.

Electronic Prescriptions and the eRezept

Since January 2024, prescriptions for GKV patients are issued electronically via the eRezept system. Your doctor will either provide you with a digital QR code in the official Gematik eRezept app or print a physical QR code for you to show at the pharmacy. A standard GKV prescription is valid for 28 days from the date of issue, so be sure to fill it promptly.

Dental Coverage Under GKV: The Basics You Get

Dental care in Germany operates on a two-tier system. Public statutory insurance (GKV) covers medically necessary standard treatments—what the law calls Regelversorgung, or regulated standard care. Anything beyond that standard list is your responsibility unless you buy supplementary insurance. This distinction explains why many expats feel dental costs catch them off guard.

What GKV Actually Covers

• Two annual dental check-ups (examinations and oral hygiene advice)
• Basic cleanings and descaling of teeth
• Simple fillings for front teeth using standard plastic materials
• Routine root canal treatment when medically necessary
• Tooth extractions, including wisdom teeth
• Fixed subsidies (not full coverage) for crowns, bridges, and dentures, paid as a percentage of the cost of the standard treatment only

For dentures, crowns, and bridges, GKV typically contributes only 50 to 60 percent of the standard care cost. This percentage is fixed, and you bear the remaining balance yourself. If your dentist recommends a higher-quality material—such as ceramic instead of metal for a crown, or a newer implant technique—GKV will not fund the upgrade, and you must pay the full difference out of pocket.

What GKV Does Not Cover

• Professional teeth cleaning (Zahnreinigung) beyond the annual check-ups
• Implants and advanced implant work
• Inlays and premium fillings (for example, tooth-coloured composite restorations for back teeth)
• Ceramic or premium crowns (only the cheapest metal option is covered)
• Orthodontics for adults
• Cosmetic or aesthetic dental treatments

The Heil- und Kostenplan

Before your dentist performs any major work, they must prepare a treatment and cost plan called a Heil- und Kostenplan. This document outlines the planned treatment, the expected GKV subsidy, and your estimated personal contribution. Your dentist submits this plan to your health insurance fund for pre-approval. Always request a copy so you know exactly what you will pay before committing to treatment. This protects you from surprise bills and gives you time to decide whether to pursue supplementary insurance or seek a second opinion.

Supplementary Dental Insurance: Zahnzusatzversicherung

Because GKV leaves significant gaps, especially for crowns, implants, and professional cleanings, supplementary dental insurance—called a Zahnzusatzversicherung—has become the standard way expats protect themselves from high dental costs. Over 17 million people in Germany now hold supplementary dental coverage, a figure that has continued to grow as treatment costs rise.

What Supplementary Dental Insurance Covers

A Zahnzusatzversicherung fills the gaps left by GKV. Depending on the plan you choose, supplementary coverage can include professional teeth cleaning, dental implants, ceramic restorations, bridges, crown upgrades, and in some plans, orthodontic treatment for adults. Many plans reimburse anywhere from 75 to 100 percent of eligible treatment costs, though the exact percentage depends on the tariff you select. Some plans offer immediate coverage with no waiting period, while others impose initial limits (for example, covering only 800 euros in the first year, then increasing by 800 euros annually).

Cost and Eligibility

Supplementary dental plans typically start at around €10 per month and can go higher depending on your age, chosen coverage level, and the provider. Anyone with GKV can purchase supplementary dental insurance, regardless of employment status. However, some plans come with waiting periods or initial benefit limits if you have pre-existing dental work that needs completing. It is important to read the fine print about what treatments are excluded or limited in the first few years.

How Claims Work with Supplementary Insurance

Unlike some health systems, you do not hand over an insurance card at the dentist's reception desk for supplementary dental coverage. Instead, you pay the dentist directly in full, then submit your invoice (Rechnung) to your Zahnzusatzversicherung for reimbursement. Reimbursement typically arrives within two to four weeks, though some insurers with digital app submission process claims faster. This means you must have cash on hand or be prepared to pay upfront before receiving reimbursement.

Supplementary Insurance for PKV Patients

Even if you have private comprehensive health insurance (Private Krankenversicherung or PKV), you may still want supplementary dental coverage. PKV plans typically include 20–30 percent co-pays for crowns, implants, and orthodontics. A standalone Zahnzusatzversicherung can often reimburse up to 100 percent of these costs, providing better protection than your base PKV plan. Additionally, many PKV policies offer annual refunds if you do not submit claims; using your PKV for dental work forfeits that refund, while a separate dental policy keeps your PKV record clean and your bonus intact.

Other Gaps: What Else Does GKV Not Fully Cover

Beyond prescriptions and dentistry, GKV provides medically necessary care but excludes or limits other services. The most common gaps include private hospital rooms, certain alternative or complementary therapies, and advanced vision care. A broader supplementary insurance policy—called a Zusatzversicherung—can help fill these gaps as well.

Supplementary Health Insurance Beyond Dental

• Private hospital rooms (Stationäre Kranken-Zusatzversicherung): upgraded accommodations and private hospital care
• Outpatient treatment: specialist physician visits, certain therapies, and preventive care not covered by GKV
• Vision care and eyeglass subsidies
• Alternative and complementary medicine (homeopathy, acupuncture, herbal treatments)
• International travel medical coverage and repatriation
• Accident insurance

Many expat-friendly digital providers—such as Ottonova, Feather, and Getsafe—offer these supplementary policies with English-language support and flexible online enrollment. Basic supplementary plans often cost between €10 and €20 per month, making them an affordable way to extend your GKV coverage.

Planning Ahead: What You Should Do Now

When you first settle in Germany and enroll in GKV, understand that your basic coverage is solid for emergencies and common medical needs. However, gaps exist in dental care and certain elective services. The best strategy is to evaluate your personal priorities early—especially if you have existing dental work or expect future treatment—and decide whether supplementary insurance makes sense for your situation.

1. Get a dental check-up within your first months in Germany. Your new dentist can advise you on needed work and estimated costs, helping you decide whether supplementary insurance is worth buying.
2. Ask your Krankenkasse for a full list of covered services and co-payment rules. Different insurance funds offer slightly different benefits and may have varying digital services.
3. If you take regular medications, calculate your annual co-payment burden and consider whether you are likely to hit the annual cost cap.
4. Compare supplementary insurance plans from digital providers with English-language support before buying. Many offer free consultations.
5. Be wary of starting major dental or medical treatment before understanding what GKV will and will not cover. A Heil- und Kostenplan is your friend—insist on one.

Germany's healthcare system is efficient and affordable by international standards. With the right insurance choices and a clear understanding of what GKV covers, you can confidently manage your health and dental costs while living abroad.