Does health insurance cover the cost of braces?

This question is frequently asked, and until 2001, the answer was usually “yes.” Until then, only a small percentage of treatments for children and adolescents up to the age of 18 were not covered by statutory health insurance.

However, this has unfortunately changed as a result of cost-cutting measures in the healthcare system. Since early 2002, the so-called Orthodontic Indication Groups (KIG) have been in effect. According to these guidelines, the severity of existing dental and jaw malformations must be defined. Only findings classified as KIG 3 to 5 are covered by health insurance under the new regulations. For findings classified as KIG 1 and 2, insurance no longer covers the costs.

Important consideration: The classification, however, is merely a measure of the cost-effectiveness of treatment. It says nothing about medical necessity. Numerous patients with misalignments classified as KIG 1 and 2 present serious health risks and therefore require treatment from a medical perspective. In such cases, the patient’s parents must decide whether they want correction of the jaw or dental misalignment for their child and are willing to pay for the orthodontic treatment costs themselves. Often, this is a decision where not only aesthetic reasons are decisive, but also the prevention of later secondary diseases.