Cost sharing for braces (Zahnspange) for children and teenagers under statutory health insurance (GKV): how the 20 % / 10 % and refund system works
When orthodontic treatment with braces (Zahnspange) for children or adolescents is covered by statutory health insurance (GKV), a system of temporary co-payment applies:
usually 20 % per child,
10 % for additional siblings,
and this amount is fully refunded once treatment has been successfully completed.
Here are the details:
Situation
Initial payment
Refund
One child in treatment (KIG levels 3–5)
Parents pay 20 % of the total treatment costs as a co-payment, usually in instalments over the course of the treatment.
After the final treatment report and a certificate of successful completion, the health insurance fund refunds the full 20 % co-payment (verbraucherzentrale.de).
Two or more children in treatment at the same time
For each additional sibling, parents pay only 10 % of the treatment costs.
These 10 % are also fully refunded at the end of treatment, once the completion certificate has been submitted.
Adults
For adults, GKV only covers orthodontic treatment in rare exceptional cases, such as severe congenital malformations or major injuries.
In all other cases, adults must bear the orthodontic costs themselves.
The co-payment (20 % or 10 %) is refunded after successful completion of treatment and submission of a completion certificate issued by the orthodontist.
You must keep all original invoices and receipts and attach them to your refund application to the health insurance fund (berliner-sparkasse.de).
Tip: Use the official refund form provided by your health insurer to make the process quicker and smoother.
The temporary co-payment is intended as an incentive for families to see the treatment through to the end and to attend check-ups regularly – for the benefit of the child and the treatment outcome.
This mechanism applies only to children and adolescents whose treatment falls into medical indication groups KIG 3–5, in line with the statutory principles of “appropriate, necessary and economical” care under SGB V (kfo-luedinghausen.de).
If GKV covers braces for a child, parents initially pay 20 % of the costs (or 10 % for each additional sibling).
Once treatment is completed and the completion certificate and invoices are submitted, this amount is fully refunded.
The system applies only to children in specific medical indication groups (KIG 3–5); adults are covered only in special, exceptional cases.
The editorial team of this website strives to provide accurate information based on thorough research and multiple sources. Nevertheless, errors cannot be completely ruled out and some details may be uncertain or subject to change. Therefore, the contents of this article should be regarded as an initial guide; for binding and up-to-date information, please always consult the competent authorities and qualified professionals.
