3 treatment baskets are created to adapt to various types of situation. The prices covered in the care basket called "basket remains at charge 0 for the patient" or in the "care basket at controlled rates" will vary according to the nature of the materials used and the location of the tooth concerned. The principle adopted is that a visible tooth must be able to be replaced by materials which guarantee an aesthetic quality, but that this is less necessary for a non visible tooth like a molar (see infographic).
The care basket "remains at charge 0"
It allows the patient to be reimbursed 100% by compulsory health insurance and the mutual (complementary health) for fitting prostheses. It will apply to almost half of the treatments practiced today. It will be implemented in 2 stages: on January 1, 2020 for crowns and bridges and on January 1, 2021 for dentures.
The basket of treatments "at controlled prices"
It will apply to 1 out of 4 prosthetic treatments performed today. The prices of the acts will be capped but without obligation for mutuals (complementary health) of full coverage. If a patient wishes for example a ceramic zirconia crown on a molar (back tooth), he will benefit from a capped rate but will not necessarily be reimbursed in full. The amount ultimately payable by him is estimated at € 45 on average against € 115 today.
In total, almost 3 out of 4 procedures performed today for prostheses will be subject to capped rates.
The “free price” treatment basket
It will allow the insured to freely choose the most sophisticated techniques and materials without price caps to be respected by the dentist. These treatments will be reimbursed on the basis of the social security tariff and for mutuals, according to the contracts chosen. Just under 1 in 3 acts performed today corresponds to this basket. This will notably concern crowns or bridges made entirely of ceramic, regardless of the tooth concerned.
