Dental reimbursement: what coverage?

Dental reimbursement: what coverage?

Because dental care represents a major item of expenditure, the issue of reimbursement for dental implants and prostheses is crucial. The Macif tells you all about the coverage of these acts by the mutual, like the reimbursement of the dental crown.

Price of a dental implant and reimbursement

The price of a dental implant, often high, can cause patients to hesitate, or even give up having one. For the reimbursement of a dental implant, it is, therefore, advisable to take out complementary health insurance of a sufficiently high level to reduce your remaining costs as much as possible.

How much does a dental implant cost?

A dental implant is an artificial root, inserted into the jaw bone, which replaces a missing tooth. It is on this root that we place a pillar, which can then support a crown or a bridge. The placement of a dental implant responds to two problems. Patients may choose implant-supported dentures for aesthetic reasons, but also to enjoy more comfort when chewing food. If this technique, therefore, has advantages, the price of a dental implant and the intervention to place it is generally high.

In terms of dental implants, the price varies depending on the practitioner, but also on the type of implant (titanium or zirconia). If it costs an average of €1,800, its price can quickly reach €2,200, especially in Paris. Be that as it may, the dental implant is rarely billed for less than €1,400 (1). As this dental equipment is not covered by Social Security, the prices charged are freely set. Thus, the implant is not part of the benefits covered under 100% Health (2).

What reimbursement for a dental implant?

There is no scale for the reimbursement of dental implants since this dental treatment is not covered by Social Security. Similarly, dental implants are not covered by the CMU-C (Complementary Universal Health Coverage), which has now become Complementary Health Solidarity (CSS) following its merger with the ACS (Help for complementary health).

Thus, if the reimbursement of a dental implant by Social Security is not possible, taking out complementary health insurance that offers protection adapted to your needs is essential. Reimbursement of a dental implant by the mutual depends on the nature of the guarantees taken out.

At Macif, when you take out mutual health insurance (“Health Guarantee”), you can personalize it according to your needs. From level 2, we offer a fixed reimbursement of €300 per year for the dental implant. The amount of this refund even reaches €400 with level 3 and €500 with level 4.


Price and reimbursement of dental prostheses

The dental prosthesis differs from the implant in two respects. On the one hand, the prosthesis is visible (dental crown, bridge, or inlay). On the other hand, the reimbursement of the dental prosthesis is fully or partially provided by Social Security.

What is the cost of a dental prosthesis?

The price of the dental prosthesis depends on several factors and in particular on its nature. There are different dental prostheses. It can thus be a dental prosthesis on an implant, a dental veneer, a crown, a bridge, or an inlay/onlay.

In terms of dental prostheses, the price will also depend on the material used and the difficulty of the intervention. Thus, the inlay or the onlay consists of repairing a damaged tooth, while the bridge consists of filling a space between two solid teeth or being placed on an implant. The cost will be higher in the latter case. 

What reimbursement for a dental prosthesis?

The reimbursement of the dental prosthesis is ensured by the Social Security, before being completed by the mutual health insurance according to the guarantees subscribed. The convention rate for dental prostheses, i.e. the basis for reimbursement of dental prostheses set by Social Security, makes it possible to determine the level of reimbursement.

As part of the 100% Health reform, policyholders now have access to 3 different dental baskets (3), each with its own coverage rules.

  • The 100% Health basket: by opting for dental equipment from this basket, you are fully reimbursed by health insurance and by your mutual insurance company. You have a wide choice of monolithic ceramic and metal-ceramic crowns for visible teeth (4), monolithic zirconia ceramic crowns (for incisors, canines, and premolars), metal crowns, core inlays, transitional crowns, porcelain-to-metal bridges for the incisors, metal bridges, and removable resin-based prostheses.
  • The basket at controlled prices: this basket includes a set of dental prostheses whose prices are capped. Your dental surgeon will therefore not be able to ask you more for this care. You will be reimbursed up to 70% of the Social Security Reimbursement Base (BRSS) by Health Insurance and your mutual insurance company may be able to partially or fully supplement it.
  • The basket with free prices: it includes a set of prostheses, whose techniques and materials used are generally more upscale. In this case, your dental surgeon is free to practice at the rates of his choice. Health insurance reimburses you up to 70% of the BRSS and your complimentary can complete in part or in full.

The calculation of reimbursement of the mutual for the dental prosthesis is simple. At Macif, depending on the level of protection you have chosen, the amount of your coverage can be expressed in two different ways.

  • In percentage: this means that the amount of your reimbursement is calculated about a certain percentage of the BRSS. Let’s take the example of the fitting of a dental crown (5) for which the BRSS is €120 (6). If your contract provides for reimbursement of up to 300% of the BRSS, this means that you will be reimbursed a maximum of €360 (including health insurance cover).
  • In euros: in this case, the amount appearing on your contract corresponds to the maximum reimbursement to which you can claim for this type of treatment or prosthesis. Note that this may be a maximum amount per act or year.

Dental crown reimbursement

The price of a ceramic crown is higher than that of a metal or ceramic-metal crown. The latter is ceramic on the visible side and metal on the non-visible side. It is favored for its aesthetic appearance and its quality/price ratio.

Whichever prosthesis you choose, the basis for reimbursement of the dental crown by the Sécu will be the same, namely 120 €. This applies to a crown on an implant or a crown on a tooth. This support is completed thanks to the reimbursement of the dental crown by the mutual insurance company, according to the level of guarantees subscribed. 


Dental reimbursement: braces and orthodontics

Dental reimbursement also concerns orthodontics, in particular in the case of the installation of dental appliances, but also conservative care and prosthetic procedures, such as the installation of a dental crown.

Dental appliance: what reimbursement?

What is the reimbursement for orthodontics and braces? In the event of installation of a dental device, its price and its reimbursement vary according to its type, as for the dental implant. We find for example the dental appliance clipped on the implant or the removable partial appliance. For example, the BRSS for a brace replacing 1 to 3 teeth is €64.50. For a complete brace of 14 teeth, the basis for reimbursement is €182.75 (7).

The mutual then offers a reimbursement based on that of Social Security, about the complementary health contract that you will have taken out and the guarantees chosen.

Orthodontics: how is it reimbursed?

Orthodontics is for both adults and children. This specialty aims to correct anomalies in the positioning of the teeth and jaws, by fitting rings, elastics, or even gutters. Note also that the price of a dental gutter, rings, or elastics depends on many criteria, including the dentist performing the procedure and the materials used. 

Reimbursement of dental splints by Social Security is not systematic. It depends on medical necessity. The dental tray for bruxism, i.e. an unconscious movement of clenching or grinding the teeth, is taken care of. As for the reimbursement of the mutual, the latter will depend, again, on the guarantees you have taken out. 


Coverage of social security and mutual insurance for dental care

In terms of dental care, what does Social Security reimburse, and on what basis? What about the mutual? Macif takes stock.

What basis for reimbursement for dental social security?

The Social Security dental reimbursement basis allows you to know the level of your coverage before the intervention of the mutual insurance company. The amounts indicated on the Ameli site for dental reimbursement illustrate the diversity of prices charged for dental care. For example, the reimbursement of dental bridges by Social Security is made based on €279.50, with a reimbursement rate of 70%. Thus, the reimbursement by Health Insurance for this type of procedure amounts to €195.65. For a final complete resin appliance with 14 teeth, the basis for reimbursement is €182.75, with a rate of 70%. You will therefore be reimbursed up to €127.93. 

To lower the bill for your dental care, you can opt for an operation in a dental center, where the prices are more affordable, or choose a mutual insurance company that offers a level of guarantees adapted to your needs.

Calculation of dental insurance reimbursement

With the mutual, the maximum dental reimbursement depends on the nature of the care and the level of guarantees. There are several types of health insurance coverage. The fixed dental reimbursement, expressed in euros, is calculated according to each mutual insurance company and the formula subscribed. The BRSS percentage reimbursement means that the health insurance covers a given percentage of the Social Security reimbursement basis, for example up to 100% of the basic rate.

At Macif, we offer you a complementary health policy adapted to everyone’s needs. Thanks to a wide choice of formulas and levels of equipment, you have 11 different combinations of cover, allowing you to benefit from tailor-made covers for your medical devices, particularly dental ones.