Braces for adults: does the health insurer pay?

For adults the statutory health insurer covers orthodontic treatment only in exceptional cases, for example for severe jaw misalignments that require combined jaw surgery. Otherwise braces are a self-pay service. It is important to check the entitlement in each individual case.

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Your chances of getting your money back

For adults the statutory health insurer generally does not pay for orthodontics. An exception applies for severe jaw or tooth misalignments that make combined jaw-surgical and orthodontic treatment necessary.

If such an exceptional case exists, you can apply for cost coverage. If it is refused, you can lodge an objection within one month and prove the medical necessity.

What you should do now

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1. Clarify the indication
Have an orthodontist check whether a medical exceptional case exists (e.g. severe misalignment requiring surgery).
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2. Apply for cost coverage
In an exceptional case, submit the treatment plan and apply for cost coverage from the insurer.
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3. Object if refused
Lodge an objection within the deadline and prove the medical necessity with findings.
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4. Check self-payer options
If there is no exceptional case, compare costs and possibly a supplementary dental insurance (note waiting periods).

How to spot the scam

You are promised a 'covered service' even though there is no exceptional case.
The medical necessity is not documented.
High advance payments are demanded without a clear plan.

Frequently asked questions

Does the insurer pay for braces for adults?

Generally no. For adults the statutory health insurer covers orthodontics only in exceptional cases, for example for severe jaw misalignments that require combined jaw-surgical and orthodontic treatment.

How do I get cost coverage in an exceptional case?

Have the indication determined by an orthodontist, submit the treatment plan and apply for cost coverage from the insurer. If it is refused, you can lodge an objection within one month and prove the necessity.

What if I am a self-payer?

Then you bear the costs yourself. Compare treatment and cost plans and check a supplementary dental insurance, but note waiting periods and that treatments already planned often can no longer be insured.

Take action now

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.