What actually decides it: the KIG grading system
KIG exists to make an inherently subjective judgement — “is this bad enough to treat at public expense?” — into something measurable and comparable across the country. It was introduced precisely so that the answer does not depend on which practice you happen to walk into.
How it is assessed
At the start of planning, the treating dentist or orthodontist examines the bite and measures it against defined criteria. Among the things being looked at:
- how far the upper front teeth stand ahead of or behind the lower ones
- how much the teeth overlap vertically, including a deep bite or an open bite where the front teeth do not meet at all
- whether the arches meet correctly sideways, or sit in a crossbite
- how much crowding there is — whether there is genuinely not enough room in the jaw for the teeth
- whether teeth are missing, blocked from erupting, or have failed to appear at all
- whether there are underlying anomalies such as a cleft, or a marked skeletal discrepancy between the jaws
Each criterion has thresholds, several of them expressed in millimetres. The measurements produce a grade. This is why an examination, and usually current images, are needed before anyone can tell you whether cover applies — and why a grade cannot be given over the phone.
The five grades in plain English
| Grade | What it broadly means | Statutory cover |
|---|---|---|
| KIG 1 | Slight deviation. The bite functions; the issue is essentially about appearance. | No |
| KIG 2 | Mild deviation. Visible, but with little functional consequence. | No |
| KIG 3 | Pronounced deviation with a real functional effect. | Yes, under 18 |
| KIG 4 | Severe deviation. Function, cleaning or long-term tooth health are affected. | Yes, under 18 |
| KIG 5 | Extreme deviation, including major anomalies and missing or impacted teeth. | Yes, under 18 |
Two things about this table catch people off guard.
A KIG 1 or 2 finding is not “nothing”. It means the bite works well enough that the community of insured people is not asked to pay for changing it. It does not mean your dislike of your front teeth is imaginary, and it does not mean treatment would be pointless. It means the cost is yours.
A high grade is not a disaster. Plenty of KIG 4 findings are straightforward to treat, particularly in a growing child. The grade describes the deviation, not the difficulty.
Who checks the assessment
The grade is set by the treating practice in the treatment plan and submitted to the fund. The fund reviews the plan and may have it checked by its medical review service before approving. If a plan comes back rejected, that is not the end of the road — see the section on what to do when the answer is no.
The path from examination to approval
The sequence matters more here than in almost any other area of German dentistry, because getting it out of order can cost you the entitlement entirely.
1. Examination and diagnostics. The bite is examined, models or digital scans are taken, and imaging is made where the case needs it. Without this, no grade and no plan.
2. The treatment plan is drawn up. It sets out the finding, the KIG grade, the planned appliance, the expected duration and the costs — including which items are standard treatment and which are private extras.
3. The plan goes to the fund. This is a formal submission, and it happens before treatment starts. Processing typically takes a few weeks; how long your fund takes varies from fund to fund, exactly as it does for dental treatment and cost plans (Heil- und Kostenplan, HKP).
4. Approval arrives — then treatment begins. Not the other way round. Anything bonded, fitted or adjusted before the approval is at your own risk financially. If you come from a system where you get treated first and claim later, this is the single habit worth unlearning on arrival in Germany.
5. The fund pays as treatment runs, holding back a share that is refunded to the family once the treatment is completed as planned. That mechanism, and the invoices that come with it, are covered in detail in What does a brace cost in Germany?.
Children, teenagers, adults: where the line falls
Under 18
This is the group the system is built around, for a straightforward reason: while a child is still growing, the jaws can be influenced, not just the teeth. Cover applies to standard treatment for findings at KIG 3 and above. Children are normally covered through a parent’s statutory insurance, so the decision sits with the family, not with the child’s own policy.
There is no advantage in rushing and none in waiting for its own sake. The right moment depends on the type of problem — some findings are treated best around the change of dentition, others once most permanent teeth are through. When treatment should start is its own subject: When do you actually need a brace? Signs and timing.
Turning 18 during treatment
A treatment that was properly approved while the patient was still a minor does not simply collapse on their eighteenth birthday. The approval covers the planned course. What you should not do is start a new, unapproved phase after that birthday and assume it is covered. If a plan is likely to run close to the line, ask the practice to say so explicitly and put the timing in writing.
Adults
For adults, orthodontics is normally a private service. The exception in statutory insurance is narrow and specific: severe jaw anomalies where orthodontic treatment is combined with corrective jaw surgery. This is not a route into cover for crowded front teeth or a relapse after a childhood brace — it applies to skeletal discrepancies that cannot be resolved by moving teeth alone.
That does not make adult treatment unusual. It makes it a decision you take yourself, on a written plan, with a real price on it. Our own clear aligner (Aligner) treatment is offered in three variants — 1,049 €, 2,800 € and 3,699 € — depending on how much movement the case requires; details of the treatment itself are here: Clear aligners – service page (EN).
"Approved" does not mean everything is paid
A point that causes more friction than any other: statutory cover pays for the standard version of treatment. The system defines a sufficient way of correcting the finding, and that is what is funded.
Anything beyond it is private — ceramic or tooth-coloured brackets on visible teeth, self-ligating systems, appliances bonded behind the teeth, aligners chosen instead of a fixed appliance, extra digital planning, and certain retainer solutions. These are legitimate options, sometimes very good ones. They are simply not part of what was approved.
So when the approval letter arrives, read the plan alongside it and check that covered items and private items are listed separately with individual prices. If they are merged into one figure, ask for them to be separated before you agree to anything.
Private insurance, supplementary cover and the timing trap
Private health insurance (private Krankenversicherung, PKV). Orthodontic benefits vary widely between tariffs — some are generous for children and restrictive for adults, some cap annual payouts, some exclude adult orthodontics altogether. Read the orthodontic clause itself rather than the summary brochure, and get written confirmation from the insurer on the basis of the actual plan before treatment starts.
Supplementary dental insurance (Zahnzusatzversicherung). Tariffs that include orthodontics typically cover a tariff-dependent share of eligible costs depending on the tariff. The trap is timing. A policy taken out after a bite problem has already been diagnosed will normally not pay for that problem, and children’s tariffs generally have to be in place long before a brace is on the horizon. If you have a five-year-old and you are wondering whether to bother, that is the moment to look into it — not the day the orthodontist first mentions treatment. Broader context: Is supplementary dental insurance worth it?.
One thing you may have read about and can set aside here. There is a draft law under discussion in Germany that would change the fixed subsidies (Festzuschüsse) for dentures — crowns, bridges, dentures. It has passed cabinet but not the legislative process, so it is a proposal and nothing more; and it concerns prosthetic subsidies, not orthodontic cover. If you have seen headlines about dental cover being cut, they are not about braces.
If the answer is no: what you can realistically do
A KIG 1 or 2 finding, or an adult case outside the surgical exception, means the fund will not pay. That is a financial answer, not a medical one. Your options are real:
Ask what the grading was, and why. You are entitled to know the finding and the grade. If something significant appears to have been left out of the assessment — an impacted tooth, a crossbite, a marked skeletal discrepancy — say so and ask for it to be reviewed. A second opinion is legitimate and nobody should take offence at it.
Separate “not covered” from “not needed”. These are different statements. Many KIG 2 findings are perfectly reasonable to treat privately, especially where cleaning is difficult or where a specific tooth is being worn down. Ask directly: if I were paying either way, would you advise treating this?
Scale the treatment to the problem. Not every case needs a full multi-year plan. Limited corrections that address the front teeth or a single rotated tooth exist, take months rather than years, and cost accordingly.
Use the free first consultation before you decide anything. Finding out what your case actually involves costs nothing with us, and it turns an abstract worry into a number and a timeline.
Look at the payment side rather than only the price. Instalment payment (Ratenzahlung) is possible for private treatment, subject to a credit decision.
Special situations if you moved to Germany
Treatment started in another country. A German fund does not simply continue what another health system began. It needs its own examination, its own KIG assessment and its own approved plan. Bring everything you have — previous plans, photographs, X-rays, the name of the appliance in use. It shortens the assessment and can prevent repeat imaging.
Changing health insurance funds mid-treatment. Switching funds does not cancel an approved orthodontic treatment, but the paperwork has to follow you. Tell both the practice and the new fund in writing, and keep copies of the original plan and approval. This is not the moment to rely on records being passed on automatically.
Students and researchers. If you are insured under statutory student insurance, the same rules apply — including the under-18 threshold, which most students have already passed. Adult orthodontics will normally be a private decision, and a modest one if the case is limited.
Language. A cover decision you cannot read is a cover decision you cannot check. Patients travel to us from across NRW — Düsseldorf, Cologne, Bonn — and from further away in Germany, frequently because being able to go through a plan in English changes what they understand about it. Practical help on finding care in English: English-Speaking Dentist in NRW.
What a normal process looks like — and when to ask for a second look
The threshold is the eighteenth birthday. Treatment that begins as an approved plan before then is covered under that approval. New treatment started as an adult is covered only in the narrow case of severe jaw anomalies treated together with jaw surgery.
You can ask for the assessment to be reviewed, and you can obtain a second opinion — particularly if you believe a relevant feature was not taken into account. What you cannot do is negotiate the grade upwards for a bite that measures as a grade 2. If it stays at 2, the honest question becomes whether the treatment is worth doing privately.
Aligners are generally treated as a private alternative to the standard appliance rather than as the covered standard treatment itself. In a covered child’s case that usually means the fund contributes to the standard version and the aligner difference is yours. In adult cases the whole treatment is private in any event.
Usually a few weeks, though processing times differ between funds. School holidays are a good time to have the plan submitted rather than the appliance fitted.
Cover follows the finding, the plan and the approval rather than a job title. What matters is that the case is properly assessed and treated by someone competent to handle it. Where a case belongs with a specialist orthodontic approach, we will say so directly rather than begin something that does not fit.
Approved treatment does not lapse because you move. Ask for your records — plan, approval, imaging, current stage — and hand them to the new practice at the first appointment. Continuity is a paperwork problem, not an insurance problem, as long as you keep the paperwork.
Cover for braces in Germany runs on a measurement, not on a conversation. KIG grades 3 to 5 in a patient under 18 mean statutory insurance carries the standard treatment; grades 1 and 2 mean it does not, at any age; and adults are covered only in severe cases treated alongside jaw surgery. Approval comes before treatment, always. And “covered” means the standard version — the extras are a separate decision, made with separate prices in front of you.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
