Does dental insurance reimburse 100% of dental costs?
NO, there is no dental insurance plan on the market that covers unlimited dental costs.
100% reimbursement doesn’t mean unlimited cost reimbursement. Many customers get confused by the term 100% reimbursement and feel cheated when dental insurance companies reimburse only part of the costs.
Example 1
Suppose your dental insurer reimburses 100% of the costs and has a reimbursement limit of 1000€.
Case 1: Invoice of 900€
In this case, 100% of the invoice amount (900€) is lower than the reimbursement limit. So, the insurer will reimburse the complete cost, i.e., 900€.
Case 2: Invoice of 1200€
In this case, 100% of the invoice amount (1200€) exceeds the reimbursement limit. So, the insurer will reimburse up to the maximum limit, i.e., 1000€.
Example 2
Suppose your dental insurer reimburses 80% of the costs and has a reimbursement limit of 1000€.
Case 1: Invoice of 900€
In this case, 80% of the invoice amount (720€) is lower than the reimbursement limit. So, the insurer will reimburse the complete cost, i.e., 720€.
Case 2: Invoice of 1500€
In this case, 80% of the invoice amount (1200€) exceeds the reimbursement limit. So, the insurer will reimburse up to the maximum limit, i.e., 1000€.
What reimbursement limits do dental insurance companies apply?
There are two types of reimbursement limits when it comes to dental insurance.
- GOZ maximum rate limit
- The reimbursement limit during the first four years of the contract
GOZ maximum rate limit
GOZ (Gebührenordnung für Zahnärzte) is the fee schedule for dentists in Germany. It regulates the costs of dental services charged by dentists.
Here is how the dental costs are calculated per the GOZ fee schedule.
Dental cost = Score x Point Value (5.62421 cents) x Factor (1 to 3.5) x Nr of teeth
Where,
- Score is a number assigned to each dental service listed in the
GOZ fee schedule. For example, the
score assigned to “Professional dental cleaning” is 28.
- Point value is
5.62421 cents [
1] as of 2025.
- Factor varies from
1 to 3.5. The dentist determines the
factor based on the difficulty of the treatment.
So, professional dental cleaning costs vary between 47.24 € (28 * 5.624 * 1 * 30) and 165.34 € (28 * 5.624 * 3.5 * 30).
Dental costs can vary greatly depending on which factor the dentist uses to calculate them. Dental insurance companies limit the reimbursement to the maximum GOZ factor.
So, if your dentist uses a factor higher than the maximum GOZ factor to calculate the dental costs, you pay the excess.
What is the maximum GOZ factor in Germany?
Dental services are divided into three categories, and each category has a separate maximum GOZ factor.
- Personal services: Up to 3.5 factor
- Laboratory service: Up to 1.3 factor
- Medical/Technical services: Up to 2.5 factor
Reimbursement limit during the first four years
Every dental insurance company applies a reimbursement limit in the first four years of the contract. The insurer reimburses up to the maximum limit set in the contract during these years.
From the fifth year, there are no reimbursement limits.
Another false marketing - Immediate dental coverage
"100% reimbursement" was not enough; dental insurers went ahead and rolled out a new plan that offers "up to 100% reimbursement immediately, even if the treatment is underway."
This is another case of false marketing, so be aware of it.
A classic supplemental dental insurance doesn't cover the costs of treatments that have already been planned or initiated. This is also the reason why you should consider getting dental insurance before developing dental problems.
However, there are dental insurance plans that offer up to 100% coverage of ongoing dental treatments. It seems interesting, but the reality is far from what the insurers market.
Example 1
According to Finanztip research, the “Sofort ZEK” tariff from Ergo advertises immediate coverage and up to 100% cost reimbursement. However, in reality, Ergo's dental insurance plan only doubles the subsidy your public health insurance company pays.
This is sufficient for simple dentures. However, if you want higher-quality ceramic crowns or implants, you'll pay a significant portion out of your own pocket.
- Two all-ceramic crowns cost €2,510.
- Public health insurer pays a fixed subsidy of €736.
- Ergo also adds the same amount on top, i.e., €736.
- Amount you must pay from your pocket = 2510 - (736 + 736) = €1,038
Don't forget the monthly premium of €37.60. Moreover, you're tied to the contract for two years. So, the total premium you'll pay for the immediate plan is €902.4.
Additionally, the dental insurer imposed the following reimbursement limits.
- First year: up to €1,000
- In the first two years: up to €2,000.
Conclusion
Don't buy a dental insurance plan by trusting what you read on the insurer's landing page. You must understand the fine print.
Moreover, be extra cautious if you encounter something that seems too good to be true.
In our research, we found the following two dental plans to be the best. You can read the complete report here.
