Fixed Allowance for Dental Prosthetics 2026: Amounts, Calculator & Hardship Provision

The fixed allowance is the contribution your statutory health insurance (SHI) makes toward any medically necessary dental prosthetics. Since the reform in January 2005, it has been finding-based — meaning: The insurance no longer bases its payment on the actual restoration chosen, but on the so-called standard care (Regelversorgung) defined for the respective dental finding in the catalog.

Specifically: If you have a restorable tooth with extensive destruction of the clinical crown (Finding 1.1), the fixed allowance catalog defines the standard care — a veneered metal crown in the visible area, a full cast crown in the non-visible area — and sets a finding-based fixed amount for this finding. Your insurance pays exactly this amount. If you choose a higher-quality restoration (e.g., all-ceramic), the allowance remains the same; you pay the difference yourself.

The legal basis is Section 55 SGB V in conjunction with the Fixed Allowance Directive of the Federal Joint Committee (G-BA). The catalog is published by the National Association of Statutory Health Insurance Dentists (KZBV) in the form of an annual "Fixed Allowances Billing Guide" and applies nationwide.

The system has three key characteristics that patients should know:

• Finding-oriented: The amount of the allowance does not depend on how expensive your preferred solution is, but solely on the diagnosed finding.
• Material-neutral: Regardless of the chosen material (e.g., all-ceramic instead of metal-ceramic), the fixed allowance remains the same.
• Bonus mechanics: Through regular preventive care (gapless bonus booklet), the allowance increases by 10 to 15 percentage points.

For patients, this is good to know: Your out-of-pocket share depends not only on the price of the dental prosthesis but always on your bonus and, if applicable, hardship status. The specific finding-based amounts (KZBV billing guide) are adjusted annually — for the binding amount for your finding, please use our fixed-allowance calculator.

On December 5, 2025, the Federal Joint Committee (G-BA) resolved to adjust the fixed allowance amounts effective January 1, 2026. Basis of the recalculation: the nationwide point value for dental services in prosthetics rose to €1.1844 (+4.78% vs. 2025), and the prices for dental laboratory services (BEL II) also rose by 4.78%, with modifications to individual BEL II items. How much the allowance for a single finding changes depends on its composition.

The fixed allowance per finding is defined in a uniform, nationwide catalog — the KZBV Fixed Allowances Billing Guide. It contains the concrete standard-care amounts for all relevant findings (crowns, post-and-cores, bounded edentulous spaces, shortened dental arches, full dentures). The catalog is updated annually; the 2026 version is "Valid from 01/01/2026".

Each finding has four allowance tiers:

• 60% base subsidy — standard without a bonus-booklet advantage.
• 70% — with 5 consecutive years of a complete bonus booklet.
• 75% — with 10 consecutive years of a complete bonus booklet.
• 100% hardship — if your income is below the annually set hardship threshold, the standard care is fully covered.

For the current amount per tier for your specific finding, use our fixed-allowance calculator. The official source of the nationwide amounts is the KZBV (kzbv.de/zahnaerzte/rechtsgrundlagen/festzuschuesse/).

Important: The fixed allowance does not change the total cost of your restoration — it only affects the portion covered by the health insurance. The laboratory fee, the dental fee according to BEMA/GOZ, and any additional services such as CBCT or implant surgery remain calculated separately. The individual out-of-pocket share is the difference between the total costs and the fixed allowance; it is transparently disclosed in the treatment and cost plan (HKP).

The fixed allowance system recognizes three types of restorations. Your choice determines the relationship between the fixed allowance and your out-of-pocket share.

1. Standard care (Regelversorgung)

You choose exactly the restoration defined by the fixed allowance catalog as the standard service — for example, a metal-ceramic crown in the visible area or a full cast crown in the posterior area. Billing is simplest here: The fixed allowance covers 60% (or 70/75% with a bonus) of the standard service costs according to BEMA. Your out-of-pocket share is the difference to the SHI standard service — no GOZ portion.

2. Comparable care (Gleichartige Versorgung)

You choose a higher-quality execution within the same type of therapy — for example, an all-ceramic crown instead of the standard metal-ceramic one. The crown remains a crown; only the material is upgraded. Billing:

• Standard service portion (BEMA) up to the cost of standard care — covered by the fixed allowance and insurance share.
• Surcharge for the higher-quality material (GOZ item) to be borne entirely by you.

Typical example: For an all-ceramic crown, the insurance pays the same fixed allowance as for the standard metal-ceramic care (Finding 1.1). You bear the difference between the standard care (BEMA) and the higher-quality execution (GOZ surcharge). For the concrete out-of-pocket share for your finding, see our calculator.

3. Alternative care (Andersartige Versorgung)

You choose a different therapy form than the standard care — classic example: implant instead of a bridge. The fixed allowance is still granted, but:

• The insurance share is limited to the fixed allowance for the standard care (i.e., for the bridge).
• The entire implant treatment is billed privately via the GOZ (Fee Schedule for Dentists) — implantation, bone grafting, implant crown.
• You bear the full difference between the GOZ invoice and the fixed allowance yourself.

Rule of thumb: The further you deviate from standard care, the higher your out-of-pocket share — but the fixed allowance is never lost. It reduces the bill by a fixed, finding-based amount, regardless of the type of restoration.

The bonus booklet is the most effective lever statutory health insurance patients have to reduce their out-of-pocket costs — and it costs nothing except one regular check-up per year.

How does it work?

• Annual check-up: Adults need one preventive dental examination per calendar year. The stamp in the bonus booklet documents the appointment.
• +10% after 5 years: Those who have attended their annual check-up for 5 consecutive years receive an increased fixed allowance of 70% (instead of 60%) starting in the 6th year.
• +15% after 10 years: With 10 gapless years, the fixed allowance rises to 75%.
• One gap is enough: If the stamp is missing in any calendar year, the count starts from zero again. Exception: In cases of hardship (e.g., a verifiable severe illness), the insurance can be accommodating.

Children and adolescents

For children and adolescents between the ages of 6 and 18, the semi-annual individual prophylaxis (IP appointment) applies. These appointments are also bonus-relevant. With continuous participation, the subsequent fixed allowance for dental prosthetics is increased by 10 or 15 percentage points, just as with adults.

Concrete impact

The bonus-booklet advantage adds up: for each finding, the fixed allowance increases by 16.7% (5-year bonus) or 25.0% (10-year bonus) compared to the base value — for larger restorations (e.g., multi-tooth gaps, multi-unit bridges), this is a three-digit amount per treatment plan. Your specific savings based on your finding and bonus-booklet status are shown by the calculator.

Practice recommendation

Present your bonus booklet at your first visit and have it stamped at every check-up. Lost bonus booklets can be reconstructed via the health insurance company if dentists can provide documentation over the years — but the process is tedious. An easier way: digitally photograph the bonus booklet or store it in your electronic patient record (ePA).

The hardship provision under Section 55 (2) SGB V protects insured persons with a low income from an unreasonable out-of-pocket share for dental prosthetics. Anyone recognized as a hardship case receives, on top of the fixed allowance (60%), an additional amount of 40%. For standard care, the health insurance thereby covers the costs actually incurred.

Income limits 2026

The legislator sets the limit at 40% of the monthly reference value according to Section 18 SGB IV. The reference value is adjusted annually by federal regulation. The limits are tiered as follows:

• Single individuals: 40% of the reference value per month.
• With one dependent: single limit plus 15% of the reference value.
• Per additional dependent: another 10% of the reference value.

The gross income of all family members living in the same household counts. The concrete 2026 limits and your personal calculation are shown in our hardship calculator.

Automatic recognition

Without a separate review, the following are considered hardship cases:

• Recipients of Bürgergeld / basic income support for jobseekers (SGB II)
• Recipients of subsistence assistance (SGB XII)
• Recipients of basic income support in old age and for reduced earning capacity
• Recipients of subsistence benefits under § 93 SGB XIV
• Recipients of BAföG or vocational training allowance (SGB III)
• People whose care-home costs are paid by social assistance, social compensation or soldiers’ compensation

Application process

1. Have a treatment and cost plan (HKP) prepared by the dentist.
2. Submit the HKP to the health insurance company and simultaneously file a hardship application (you get the form from your health insurance company). Attach current income proof for all household members — e.g. pay slips, pension notice or benefits notice. Your health insurance company decides which documents and which period it requires.
3. The health insurance company sets the fixed allowances and states whether a hardship case applies. Treatment should only start after approval.
4. In case of rejection: file an objection (Widerspruch) within one month of receiving the decision — in writing, electronically or in person for the record at your health insurance company (Section 84 SGG).

Important notes

• The health insurance company determines whether a hardship case applies each time it sets the fixed allowances for a treatment and cost plan — recognition is not permanent. A new HKP is checked again.
• The exemption from co-payments under Section 62 SGB V (burden limit of 2% of annual gross income, usually 1% for seriously chronically ill persons) covers statutory co-payments, e.g. for medicines. Out-of-pocket shares for dental prosthetics do not count — an exemption does not reduce them. It is independent of the dental prosthetics hardship provision and is applied for separately.
• The hardship provision only applies to standard care. If you choose comparable or alternative higher-quality care, you bear the surcharge entirely yourself.

Many patients have an income just slightly above the hardship limit. For them there is the sliding hardship scale under Section 55 (3) SGB V: an additional amount on top of the fixed allowance.

Formula

1. Reasonable burden = (monthly gross income − hardship limit) × 3
2. Additional amount = fixed allowance (60%) − reasonable burden
3. If the amount is greater than 0, the insurance reimburses it on top of the fixed allowance – at most 100% in total and never more than the actual costs.

It follows that the sliding scale applies as long as the income exceeds the limit by less than one third of the 60% fixed allowance. For small restorations such as a single crown this margin is small; for larger ones such as dentures or multi-unit bridges it is correspondingly larger.

How a bonus booklet is credited under the sliding scale is not settled clearly by the law – your health insurance decides. Worked examples and your personal calculation are in our hardship calculator.

Important: The sliding hardship scale must be applied for at your health insurance. The additional amount is reimbursed once you submit the invoice.

Using the example of a full crown (Finding 1.1), you can clearly see how the bonus tiers work:

Starting point

• Finding: tooth with largely destroyed clinical crown → Finding 1.1.
• Chosen restoration: All-ceramic crown (lithium disilicate, comparable care).
• The fixed allowance remains the same (standard care metal-ceramic); the difference to the higher-quality all-ceramic is a GOZ surcharge.

Scenario A — without bonus booklet (60%)

Base fixed allowance for standard care; you pay total costs minus the base subsidy.

Scenario B — with bonus 5 years (70%)

The fixed allowance increases by 10 percentage points and reduces your out-of-pocket share accordingly.

Scenario C — with bonus 10 years (75%)

The allowance increases by another 5 percentage points compared to Scenario B.

Scenario D — Hardship (100% for standard care)

The insurance covers the standard care entirely. For a comparable restoration (e.g., all-ceramic), you still bear the private GOZ surcharge even in a hardship case. For the SHI-compliant metal-ceramic crown, low-income insured persons effectively have no out-of-pocket share for standard care.

With supplemental dental insurance

Private supplemental dental insurance with a dental-prosthetics tariff typically reimburses a high share of the remaining out-of-pocket cost after the fixed allowance. Requirement: contract signed before the start of treatment and waiting periods expired (typically 8 months). For the concrete amounts for your finding and bonus tier, see our calculator.

A typical case in the practice — especially for patients in their late 50s / early 60s with single-tooth gaps in the posterior region:

Starting point

• Finding: one missing tooth with two restorable adjacent teeth → Finding 2.1 (bounded edentulous space with one missing tooth).
• Restoration: 3-unit metal-ceramic bridge (standard care) — the adjacent teeth are crowned as bridge abutments (Finding 1.1 per abutment tooth).

How the fixed allowance is composed

The fixed allowance for a 3-unit bridge at a single-tooth gap adds up from three components: the allowance for Finding 2.1 (the gap) plus the allowance for Finding 1.1 per abutment tooth (×2). The same logic with percentage tiers (60 / 70 / 75 / 100%) as for a single crown — the absolute amounts, however, add up, making the difference between bonus tiers much more substantial than for a single restoration.

Scenario comparison

• Scenario A — without bonus booklet (60%): base fixed allowance for standard care.
• Scenario B — with 10-year bonus (75%): significantly higher fixed allowance and correspondingly lower out-of-pocket share.

The difference between Scenarios A and B for a larger restoration like a bridge can reach a three-digit amount — this is why we actively stamp the bonus booklet at every check-up in our practice and draw attention to missed appointments.

Hardship

If your monthly income is below the hardship threshold (single individuals: 40% of the reference value), you receive a 100% fixed allowance on the standard care. For a standard-compliant bridge, the out-of-pocket share effectively drops to zero; surcharges for higher-quality materials (all-ceramic, zirconia) remain your cost even in a hardship case. Your specific calculation is handled by the calculator.

The implant is a classic alternative case: The standard care for a single-tooth gap is a bridge (Finding 2.1), not an implant. The fixed allowance is still granted — but only in the amount of the bridge standard care.

Starting point

• Finding: one missing tooth; adjacent teeth caries-free and intact. The patient does not want healthy teeth to be crowned for a bridge.
• Restoration: single implant with screw-retained all-ceramic crown — alternative care.

Billing

The SHI reimburses the fixed allowance for the standard care of the single-tooth gap — which is Finding 2.1 (3-unit bridge with 2 abutment crowns). The amount depends on your bonus/hardship tier (60 / 70 / 75 / 100%) just like any other bridge restoration.

Out-of-pocket principle

Your out-of-pocket share equals the total cost of the implant treatment (GOZ-based billing for implant, implant crown, surgical and prosthetic fees) minus the bridge-based fixed allowance. The difference compared to a bridge reflects the higher complexity of the implant — in return, the adjacent teeth remain intact, jaw bone is preserved through the implant's root force, and the restoration has an expected durability of 15–25 years (bridge mostly 10–15 years).

Peculiarities of alternative care

• The dentist bills the implant surgery entirely according to GOZ (items 9010, 9050, 9060, 9070, etc.).
• The fixed allowance is applied for in advance with the cost estimate to the insurance; the insurance approves its share.
• A supplemental dental insurance with an implant module can reimburse a large share of the remaining out-of-pocket cost.

For your specific implant calculation including bone grafting, we create an individualized treatment and cost plan in the initial consultation. The amount of the fixed allowance for your finding is shown by the calculator.

The treatment and cost plan (HKP) is the official insurance form used to apply for the fixed allowance. Without an HKP, there is no allowance — not even retroactively.

Step 1: Finding and consultation in the practice

Your dentist determines the finding, discusses therapy alternatives, and creates the HKP. The HKP contains:

• Entry of the finding for each affected tooth (e.g., "Tooth 26: Finding 1.1")
• Specification of the standard care (BEMA items)
• If applicable, comparable or alternative care options (GOZ items)
• Calculation of the expected fixed allowance (per bonus level)
• Expected out-of-pocket share

You receive the HKP as a printout — usually in 2 copies (one for the health insurance, one for your records).

Step 2: Submit the HKP to the health insurance company

Submit the HKP promptly to your health insurance company — by mail, fax, email, or via the insurance app (e.g., TK-App, AOK-App, Barmer eCare). Include:

• Your bonus booklet (for an increased fixed allowance)
• If applicable, proof of income (for a hardship application)

Step 3: Wait for the insurance decision

The health insurance company checks the HKP and informs you of the approved fixed allowances. Treatment should only begin after approval. You receive:

• The HKP returned with the insurance stamp and approved fixed allowance
• If applicable, a separate notice regarding the bonus level or hardship status

Step 4: Implementation within 6 months

The approved HKP is valid for 6 months from the date of issue. If the treatment starts later, the HKP must be recreated and re-approved — this is especially relevant in case of subsequent fixed allowance changes.

Step 5: Billing after completion

After completion, the dentist submits the final HKP with the actual costs to the health insurance company for billing. You receive an invoice from the dentist only for the out-of-pocket share — the insurance portion is settled directly.

What to do if the HKP is rejected?

• Rejections mostly occur due to formal errors (missing documents, old HKP). Complete the documents and resubmit.
• For substantive rejections (e.g., "care not necessary"): file an objection within one month of receiving the decision — in writing (e.g. by registered mail so you can prove receipt), electronically or in person for the record at the insurer. Have your dentist write a medical justification.
• For health-related exceptions (e.g., documented bruxism fracture as a reason for all-ceramic instead of metal-ceramic): commission an expert opinion to strengthen the appeal.

The dental practice of Dr. Christina Dickel in Munich-Oberföhring (adjacent to Bogenhausen) offers patients from the northeast of Munich comprehensive support for dental prosthetics and fixed allowances.

Our service promise

• Free initial consultation appointment (approx. 45 minutes) incl. clinical findings, bite-wing X-rays, and an individual HKP draft.
• Transparent cost calculation: You receive the HKP with all bonus scenarios right in the practice — before you submit it to the health insurance.
• Fixed allowance calculator directly on our website: Enter your finding, select your bonus level, and immediately see the amount for 2026.
• Collaboration with certified master dental laboratories in Munich for transparent lab costs.
• Hardship consultation: We support you with the formal application and provide medical justification for appeals if needed.

Why closing bonus booklet gaps pays off in Munich

Munich patients often live in areas with a high density of dentists — which makes the annual check-up appointment particularly easy. Those who keep their bonus booklet gapless for 10 years increase the fixed allowance by 15 percentage points; for a medium-sized restoration (e.g., 3-unit bridge), the savings quickly add up to a three-digit amount per HKP. For two dental prosthesis treatments in a lifetime, this equals the time investment of a single check-up per year — a very good time-to-benefit ratio.

Accessibility

• Address: Praxis Dr. Christina Dickel, Munich-Oberföhring
• Public transport: Subway U4 Arabellapark, Tram 16/17
• Parking directly at the building
• Appointments can be made online, by phone, or by email

If you are planning a dental prosthesis and want to know the amount of the fixed allowance in advance, feel free to schedule a consultation appointment. Alternatively, use our free fixed allowance calculator at the top of the article and receive a binding estimate for your restoration in 60 seconds.