📑 Table of Contents

1. What does German insurance cover? A complete guide to doctors, glasses and therapy
2. Basic structure of German health insurance: GKV and PKV
3. Dental Treatment: What does GKV pay for?
   • Basic Treatment
   • Dentures, Crowns and Bridges
   • Implants (Dental Implants)
   • Orthodontics (braces)
   • Why is private dental insurance necessary?
4. Glasses: Can insurance cover glasses?
   • GKV and eyeglass coverage
   • The role of private and supplementary insurance
   • Changes in the eyewear industry
5. Therapy: Mental health coverage
   • Psychotherapy
   • Sociotherapy for serious mental illnesses
   • Private therapy and supplementary insurance
6. Practical advice and recommendations
   • For dental treatment
   • For glasses
   • For therapy
7. Digital health apps and new trends
8. Conclusion
9. Frequently Asked Questions (FAQ)
   • Is dental treatment free in Germany?
   • Can I get glasses from the GKV?
   • How long do you have to wait for therapy?
   • Is it necessary to take out supplementary insurance?
   • Can I switch to PKV?

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For most people living in Germany, understanding health insurance can be a difficult task, especially when it comes to basic services like dental treatment, glasses and therapy. In my years of experience, I have seen that Pakistanis and other foreign insurance companies fail to get what they are entitled to, simply because they are not familiar with the rules.

Our team at dotzee.eu constantly strives to explain the complex world of insurance in simple language. In today’s article, we will shed light in detail on the three most important branches of German health insurance: Dentistry, Glasses and Mental/Psychological Therapy.

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🏥 Basic structure of German health insurance: GKV and PKV

There are two types of health insurance in Germany: Gesetzliche Krankenversicherung (GKV) i.e. state health insurance, and Private Krankenversicherung (PKV) i.e. private health insurance. The coverage of the two varies greatly.

Most employees are covered by GKV, where the premium is deducted in proportion to your income. PKV is usually chosen by civil servants, self-employed professionals and people with high incomes. The coverage of dental treatment, glasses and therapy in the two systems works on different principles.

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🦷 Dental Treatment: What does GKV pay for?

Dental treatment is expensive in Germany, and this is where most people are disappointed with insurance.

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✅ Basic Treatment

GKV fully covers basic dental treatments such as removing caries and filling cavities. These services are billed via your electronic health card (eGK). However, there is an important point here: you are only entitled to the cost of a filling made of the cheapest material. If you want a better and more expensive material, you will have to pay the difference yourself.

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👑 Dentures, Crowns and Bridges

This is where GKV only helps to a certain extent. The insurance company pays 60 percent of the average cost of standard care as a fixed subsidy. If you have had regular check-ups in the 5 years before starting treatment and have registered in the bonus booklet, this subsidy increases to 70 percent. In the case of 10 years of regular check-ups, it can reach 75 percent.

Remember: a 75 percent subsidy does not mean that you only have to pay 25 percent. This subsidy applies to the cost of standard care, not to the most expensive treatment you choose. The difference can be very large.

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🦷 Implants (Dental Implants)

In general, the GKV does not pay the cost of implants. Only in exceptional medical cases, such as rehabilitation after tumor surgery, can the insurance contribute to this.

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😁 Orthodontics (braces)

Orthodontic treatment is covered for children and adolescents (under 18 years of age), provided it is medically necessary. There is generally no coverage for orthodontic treatment for adults, except in very serious cases where there is an abnormal jaw structure and surgical correction is required.

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💳 Why is private dental insurance necessary?

Given these limitations of the GKV, I always recommend that if you have dental problems or may have them in the future (and who doesn’t?), it is wise to take out Zahnersatz-Zusatzversicherung.

For example, DAK-Gesundheit’s PlusGesundheit SPEZIAL tariff offers reimbursement of up to 30 percent for dental treatment, and inlays and implants are also included. There are some limits in the first year, but these limits are lifted after the fifth year.

Companies like Envivas offer PraxisExtra and PraxisTop plans that offer a co-payment of 40 to 50 percent for dental treatment, and there is no annual financial limit after the sixth year.

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👓 Glasses: Can insurance cover glasses?

This is probably the most misunderstood topic. People think that health insurance will cover glasses, when in reality it is quite the opposite.

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📊 GKV and eyeglass coverage

Around 12 million glasses are fitted in Germany every year. These figures show how the GKV views glasses.

State insurance only covers glasses in the most serious cases, such as:

• Severe visual impairment in children
• Impairment of 6.25 diopters or more in adults
• Severe visual impairment due to illness

Ordinary adults who wear glasses regularly do not receive any support from the GKV.

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🛡️ The role of private and supplementary insurance

This is where private insurance or supplementary health insurance comes in.

Large insurance companies such as the TK (Techniker Krankenkasse) do not usually cover glasses either. However, if you take out supplementary insurance, the situation changes.

DAK’s PlusGesundheit SPEZIAL tariff provides reimbursement of up to 180 euros for glasses. This amount can be repaid every 24 months, or even earlier if the change is more than 0.5 diopters.

Envivas’ PraxisExtra and PraxisTop plans also include visual aids, i.e. glasses and contact lenses.

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🔄 Changes in the eyewear industry

The Central Association of Opticians (ZVA) in Germany has long been calling for a change in the system. They want the current in-kind benefits system to be replaced by a fixed subsidy system. This would mean that everyone would receive a certain amount directly, and they would be able to buy the glasses of their choice with it. The system would be more transparent and modern, and the administrative costs would also be lower.

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🧠 Therapy: Mental health coverage

Mental health problems are now being discussed openly, and German insurance is also improving in this regard.

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🗣️ Psychotherapy

GKV covers psychotherapy, but there are some conditions.

• A referral from a GP (family doctor) is required to see a therapist
• In some cases, prior authorization from the insurance company is required for the approval of therapy
• The types of therapy are limited (usually Cognitive Behavioral Therapy and Psychodynamic Therapy)

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🤝 Sociotherapy for serious mental illnesses

If a person suffers from a serious mental illness and cannot contact a doctor or therapist themselves, they are entitled to sociotherapy. This therapy provides practical life guidance so that the patient can use medical services independently. Up to 120 hours of sociotherapy can be received over three years.

The co-payment for adults is: 10 percent of each treatment day (minimum 5 euros, maximum 10 euros per day).

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🏥 Private therapy and supplementary insurance

Therapy coverage in PKV is usually better than in GKV. You can choose from more therapists, and there is less waiting time.

Supplementary insurance is particularly useful for people who are on GKV but want more therapy options. Some supplementary plans cover therapy costs that are not included in the standard GKV package.

This is particularly important for people who are entitled to social compensation benefits. If mental problems have arisen as a result of an accident or being a victim of violence, special psychological services may be available that are not covered by general insurance.

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📌 Practical advice and recommendations

Now that you have the basics, I would like to give you some practical advice.

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🦷 For dental treatment

• Be sure to get a bonus booklet: Regular check-ups can increase your subsidy by 60 to 75 percent.
• Get a health plan (Heil- und Kostenplan) approved in advance: Get a plan approved by your insurance company before starting any dental treatment.
• Check supplementary insurance: If you have dental problems, Zahnersatz-Zusatzversicherung is a wise investment.

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👓 For glasses

• Check your needs: If your eyesight is only slightly impaired, don’t count on GKV.
• Check supplementary insurance: Many supplementary plans include 100-200 euros per year for glasses.
• Avoid expensive frames: If you are paying out-of-pocket, spend more on good lenses than on frames.

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🧠 For therapy

• Be patient: It can take time to find a therapist. Join the waiting list.
• Call 116117: This is the medical on-call service that can help you find a therapist.
• Ask your insurance: Make it clear in advance which therapies are covered and which are not.

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📱 Digital health apps and new trends

Digital health apps (Digitale Gesundheitsanwendungen – DiGA) are on the rise in Germany. There are many apps that help with depression, anxiety and other mental health problems, and the GKV covers their costs.

Similarly, changes are also taking place in the eyeglass industry. The ZVA is calling for a fixed subsidy system to be introduced, which would make it easier for ordinary people to buy glasses.

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✅ Conclusion

Although the German insurance system is complex, it is not impossible to understand. By knowing what is covered for dental treatment, glasses and therapy, you can not only save money but also get better treatment.

At dotzee.eu we strive to provide you with authentic and timely information about the world of insurance. If you have any questions, ask in the comments, we will be sure to answer.

For more information, you can visit the website of the Bundesgesundheitsministerium (Federal Ministry of Health), which provides authoritative information about the German health system.

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❓ Frequently Asked Questions (FAQ)

Is dental treatment free in Germany?
No, only basic treatments such as fillings and caries removal are free. Insurance only partially subsidizes crowns, bridges and implants, the rest you have to pay for yourself.

Can I get glasses from the GKV?
Only in very serious cases, such as a vision impairment of more than 6.25 diopters. Ordinary people have to pay for it themselves.

How long do you have to wait for therapy?
It depends on the city and the therapist, but usually it can take 3 to 6 months.

Is it necessary to take out supplementary insurance?
Not necessary, but if you want to reduce your expenses on dental treatment or glasses, it is a good option.

Can I switch to PKV?
If your income is above a certain threshold (69,300 euros in 2025), or you are self-employed, you can switch to PKV. Otherwise, you will have to stay in GKV.