What health insurance does not cover becomes most visible during your studies in dental prosthetics, glasses, medical aids and copayments. For dentures in 2026, statutory health insurance (gesetzliche Krankenversicherung, GKV) pays a fixed subsidy of 60% of the standard treatment. Adults only receive a contribution toward glasses in cases of severe visual impairment, and for medication, therapies and aids a copayment usually applies. How the GKV works in everyday student life is explained in our article statutory health insurance during your studies (in German).
The Key Points in Brief
- Dentures: The insurer pays a fixed subsidy of 60% of the standard treatment. With a complete bonus booklet it rises to 70% after five years and 75% after ten years. From 2027 it falls to 50% under the law passed.
- Glasses: Adults are only entitled in cases of severe visual impairment, for example from more than 6.0 diopters of short or long sightedness. The frame is never covered.
- Copayments: As a rule 10%, at least €5 and at most €10. From 1 January 2027 they rise to at least €7.50 and at most €15.
- Vaccinations: Compulsory benefits are the vaccinations provided for in the vaccination guideline of the Federal Joint Committee and recommended by the STIKO.
- Appointments: The appointment service 116117 arranges specialist appointments, and the waiting time may not exceed four weeks.
What Health Insurance Does Not Cover for Dentures?
For dentures, the statutory insurer does not pay a fixed percentage of your actual bill. It pays a fixed subsidy based on the standard treatment (Regelversorgung). In 2026 this subsidy is 60% of the standard treatment. With a bonus booklet that has been kept fully up to date, it rises to 70% after five years of regular check-ups and to 75% after ten years. You pay everything that goes beyond the standard treatment yourself.
Example: Suppose the standard treatment costs €600. The fixed subsidy is then €360, or €420 after five years and €450 after ten years with the bonus booklet. From 2027, at 50%, it would be only €300. If you choose a higher-quality treatment, you bear the additional costs alone.
From 1 January 2027, the fixed subsidy drops from 60% to 50% of the standard treatment. Whether your treatment plan still follows the current rules depends on the approval date: plans approved by 31 December 2026 keep them. Ask your insurer in good time, as it can also tell you the bonus levels from 2027.
A hardship rule can reduce your share of the standard treatment to zero. In that case the insurer pays 100% of the standard treatment. It applies if you receive social benefits, including BAföG, or if your income falls below a set limit. In 2026 that limit is €1,582 gross per month for a single person, plus €593.25 for the first and €395.50 for each further dependant. The individual subsidy amounts are listed by the National Association of Statutory Health Insurance Dentists (KZBV). What a private tariff covers for dental care is shown in our article dental benefits in private health insurance (in German).
Does Health Insurance Pay for Glasses?
Adults aged 18 and over are only entitled to visual aids in cases of severe visual impairment. This applies to more than 6.0 diopters of short or long sightedness or more than 4.0 diopters of astigmatism, in practice therefore from 6.25 or 4.25. The insurer never covers the frame.
Since 1 March 2025, the fixed amounts for glasses and contact lenses have been abolished. The insurer now contributes to the amounts agreed by contract, and the copayment is 10%, at least €5 and at most €10. If your visual impairment is less severe, you pay for the glasses entirely yourself. How much a private insurer reimburses for visual aids depends on the tariff. More on this is in our article visual aids in private health insurance (in German).
Which Vaccinations Does Health Insurance Not Pay For?
The STIKO issues vaccination recommendations. The vaccination guideline of the Federal Joint Committee is binding for the entitlement to benefits. Recommended vaccinations are compulsory benefits of the GKV (sections 20d and 20i SGB V). Vaccinations that are not listed there are not paid by the insurer as compulsory benefits.
The guideline sets out in detail which vaccinations are included. Ask your insurer before the appointment and have the coverage confirmed. For orientation on private tariffs, see our article vaccinations in private health insurance (in German).
How High Is Your Share of the Costs for Medical Aids?
You are entitled to hearing aids, body substitutes, orthopaedic aids and other medical aids if they are necessary in the individual case to secure the treatment success, prevent a disability or compensate for one. From the age of 18 you pay a copayment of 10%, at least €5 and at most €10 per aid. You bear any costs beyond what is necessary yourself.
The aids directory of the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) is not an exhaustive positive list. An aid outside the directory can also be reimbursed if it is necessary in the individual case. Private tariffs distinguish between an open and a closed aids catalogue. More on this is in our article medical aids in private health insurance (in German).
Which Copayments Apply and Where Do They Stop?
| Service | Copayment 2026 |
|---|---|
| Medicines and dressings | 10% of the pharmacy price, at least €5, at most €10, never more than the cost |
| Therapies (for example physiotherapy) | 10% plus €10 per prescription |
| Hospital | €10 per calendar day, for at most 28 days |
| Medical aids | 10%, at least €5, at most €10 per aid |
| Medical transport | 10%, at least €5, at most €10 per trip |
Travel costs are only covered by the insurer when they are medically necessary and prescribed. For outpatient treatment, they are usually only covered with prior approval.
Copayments are capped. The limit is 2% of your annual gross income for living expenses, or 1% for people with a chronic illness. Example: with assumed income of €12,000 per year, the limit is €240. You apply for the exemption only once you have reached the limit, and it applies for one calendar year. Shares of dental prosthetics do not count toward the limit. Your insurer clarifies which income is taken into account. The Verbraucherzentrale consumer advice centre explains the rules for exemption in detail.
From 1 January 2027, copayments rise by about 50% under the law passed, to at least €7.50 and at most €15. In hospital they will be €15 per day.
What Helps With Long Waiting Times for an Appointment?
You can reach the appointment service 116117 around the clock by phone, online or via app. It must offer you a specialist appointment within one week, and the waiting time may not exceed four weeks. For acute psychotherapy, the maximum waiting time is two weeks. As a rule you need a referral, except for eye doctors, gynaecologists, general practitioners and paediatricians. There is no entitlement to a specific doctor. The Federal Ministry of Health summarises the basics.
For psychotherapy, the psychotherapeutic consultation is the entry point. For probatory sessions and timely therapy you need a referral code. Acute treatment comprises up to 24 units of 25 minutes each and requires no approval. See also our article psychotherapy in private health insurance (in German).
What Is Not Included in Student Health Insurance?
Students insured under the student health insurance scheme (KVdS) have no entitlement to sickness benefit or maternity benefit. Maternity benefits can be claimed by those who work alongside their studies. How student health insurance obligation (in German) works in principle is explained in a separate article.
Abroad, the GKV also has limits. The European Health Insurance Card (EHIC) covers medically necessary services under the rules of the country you are staying in, and local copayments apply. The GKV does not pay for medically necessary repatriation to Germany. Private travel health insurance is common for this purpose.
How Do You Close the Gaps?
- Check for hardship: If you receive BAföG, the hardship rule may apply to dental prosthetics.
- Keep your bonus booklet: Regular check-ups raise the subsidy to 70 or 75%.
- Use the exemption limit: Collect your receipts and apply for exemption from copayments as soon as you reach the limit.
- Check supplementary insurance: Private supplementary cover can address individual areas such as dental care or glasses. Scope and exclusions differ by tariff, and the insurer asks health questions.
- Compare full cover: If you are exempted from compulsory insurance, you switch to private health insurance. This step is irrevocable. Costs and risks are covered in everything about private health insurance for students (in German).
If you are insured through your parents as a dependant, you pay no contribution of your own and receive GKV benefits, and the same limits apply. When family insurance ends is explained in family insurance during your studies (in German). If you are already privately insured, switching from private back to statutory insurance (in German) explains the strict requirements.
Frequently Asked Questions
Does private health insurance pay for glasses?
That depends on the tariff. The GKV aids directory does not bind private insurers. The tariff conditions determine whether visual aids are reimbursed and up to what amount, often with maximum amounts. Ask about the reimbursement rate and the maximum amount for each offer, and whether contact lenses are included.
What is my share of dental prosthetics?
In 2026 the fixed subsidy is 60% of the standard treatment, or 70 or 75% with a bonus booklet. You pay the rest, and all additional costs of a higher-quality treatment, yourself. In hardship cases, including for BAföG recipients, the insurer pays 100% of the standard treatment. From 2027, the fixed subsidy falls to 50% under the law passed.
How long can I wait for a specialist appointment?
The appointment service 116117 must offer you a specialist appointment within one week, and the waiting time may not exceed four weeks. There is no entitlement to a specific doctor. As a rule you need a referral, except for eye doctors, gynaecologists, general practitioners and paediatricians.
Does health insurance pay for medical repatriation from abroad?
No. Statutory insurers do not pay for medical repatriation. The EHIC covers medically necessary services under the rules of the respective country, with the copayments common there. Insurers and the consumer advice centre therefore recommend private travel health insurance that fits the length and scope of your trip.
Here Is How to Proceed Now
- Before each larger treatment, check with your insurer what it covers, and get the confirmation in writing.
- At the dentist, ask about the standard treatment and the treatment and cost plan, and keep your bonus booklet complete.
- Collect your copayment receipts and calculate when you reach your exemption limit.
- Save the number 116117 for appointment problems, and take out travel health insurance before every longer trip.
If you want to talk through your situation, you will find the way to advice on the Academycon homepage (in German).
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Related Articles
- Statutory health insurance during studies: experiences, costs, limits (in German)
- Private health insurance for students: costs and benefits (in German)
- Visual aids in private health insurance: benefits you should not overlook (in German)
- Dental benefits in private health insurance: benefits you should not overlook (in German)
- Dental supplementary insurance during studies (in German)
- Glasses paid by health insurance: entitlement in statutory health insurance (in German)
- Sickness benefit for students: does it exist? (in German)
- Copayment exemption and the cap during studies (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
