We explain the ins and out of arranging public and private health insurance in Germany and what both options can offer expats working in the country.
Expats living in Germany are eligible for state healthcare, which is funded by social security contributions. However, higher earners must sign up for private health insurance, which can offer shorter waiting times and better hospital conditions.
This guide offers information on all aspects of health insurance in Germany, including:
- The healthcare system and health insurance in Germany
- Who needs health insurance in Germany?
- Public health insurance in Germany
- How to apply for public health insurance
- Private health insurance in Germany
- Health insurance costs and reimbursements
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COVID-19 in Germany
The COVID-19 pandemic has been a difficult time for everyone. Many expats find themselves separated from family and loved ones in their home countries. As a foreigner, it is also sometimes difficult to find critical information regarding coronavirus infection rates, local measures, and restrictions, and now, thankfully, vaccinations.
The healthcare system and health insurance in Germany
The German healthcare system is one of the best in Europe. All foreigners living and working in Germany can access subsidized state healthcare, but it is mandatory for all residents to have some form of health insurance.
Once you are a resident in Germany, it is compulsory to register with either a statutory German health insurance scheme (gesetzliche Krankenkasse, GVK) or a private insurance scheme (private Krankenversicherung, PVK).
Who needs health insurance in Germany?
By law, all German residents must be insured for hospital and outpatient medical treatment, and it is mandatory to show proof of health insurance when applying for a German visa.
The vast majority of German workers remain on the state German health insurance system, but it is possible to take out more extensive private health insurance in some circumstances.
German health insurance contributions are split between employers and employees, regardless of whether you use a private or public scheme.
Public health insurance in Germany
The German state healthcare scheme covers around 90% of residents.
Both EU and non-EU nationals working in Germany are subject to compulsory state health insurance (known as statutory sickness insurance, or gesetzliche Krankenversicherung, GKV).
The public healthcare system covers people in paid employment or in vocational training, including trainees and apprentices, who earn less than €60,750 per year (2019 figures).
Spouses, civil partners, and children (up to age 23, or 25 if studying) of someone covered by state healthcare insurance are eligible for family co-insurance in certain conditions.
They don’t need to pay contributions, provided their income does not exceed €415–450 each month, depending on the situation.
Pensioners and people who receive unemployment benefits or assistance are also eligible for state healthcare.
Health insurance for self-employed people in Germany
New rules introduced in 2019 have offered a boost to self-employed workers with lower earnings.
Previously, self-employed people paid their contributions based on projected monthly earnings of €2,284 – meaning lower earners had to pay unreasonably high premiums.
Now, though, the minimum earning limit has been slashed to €1,038, potentially cutting hundreds of pounds off contributions for lower earners.
Health insurance for students in Germany
If you’re studying in Germany at a state-approved university or education institution, you’ll need to pay a premium for health and nursing care.
This currently stands at around €80 per month if you’re over 25 and don’t have any children. Up to age 25, those in full-time education can be covered for free under their family’s health insurance.
After you turn 30 or complete your 14th semester, the premiums increase by around €50 per month.
International students who are not covered by their country’s healthcare system and can’t join the state system (such as overseas graduate students) can access health insurance from around €25–30 per month.
Health insurance for foreign visitors to Germany
Citizens from the EU (European Union), EEA, or Switzerland are allowed healthcare on the same basis as German nationals if they are traveling to Germany or are temporary visitors.
To be eligible for state healthcare, you’ll need to get an EHIC (European Health Insurance Card) before you arrive. Residents planning to stay longer than a year or those working in Germany should arrange either German health insurance or join a private insurer.
An expat-friendly insurance broker such as Feather can help you find a health insurance plan that covers your medical needs, all in a language you understand.
Temporary visitors from outside the EU member area may also be able to claim state healthcare under reciprocal agreements with their home country. Otherwise, they will have to pay for healthcare services or take out travel insurance.
What is covered by German public health insurance?
German public health insurance includes inpatient care at your nearest hospital and out-patient care from doctors.
These basic services are available across the board, but if you want private medical care or your own hospital room you’ll need an additional private healthcare plan.
Some specialist care, such as eye care, dental care, and alternative medicine isn’t available in the public system or comes with limitations on what you can claim. Mental healthcare in Germany is available on the public system, but you may find more expansive options privately.
Maternity care in Germany
State health insurance typically covers the basic costs of pregnancy and childbirth.
You may, however, be charged additional costs for some of the paperwork involved in giving birth.
If you choose to give birth in a private hospital, you should check whether this is covered by your private health insurance, and discover what costs you will have to pay for the baby’s delivery and care.
Dental insurance in Germany
If you have state German health insurance, simple routine dental procedures (e.g., filling, dental hygiene) or dental emergencies are more likely to be covered.
However, pressure on the healthcare system has seen increases in co-payment amounts. This means the state is likely to only offer partial coverage for major dental work. Residents with private insurance should review their plan to see what dental coverage is on offer.
Otherwise, dental insurance in Germany is either a supplement to your health insurance plan or a stand-alone form of insurance.
Dental insurance in Germany is typically low-cost. It costs around €10–20 per month, although better coverage or lower co-payments will incur higher premiums.
You can ask your dentist for a detailed overview or quote (Heil- und Kostenplan) before agreeing to any treatment, as well as what will be covered by your dental insurance in Germany.
Sick leave in Germany
State health insurance includes sickness benefit, with your employer paying your wages for up to six weeks. Your health insurer will pay 70% of your regular salary for a maximum of 78 weeks (over a three-year period) thereafter.
Statutory sick pay (Krankengeld) pays up to €3,176 per month before tax. If you earn more than that, consider purchasing additional sick pay insurance.
How to apply for public health insurance
Usually, your employer will register you with a regional German health insurance company. However, you are free to choose the insurer of your choice, and you can do so by informing your employer within two weeks of starting work.
If you’re self-employed you’ll need to arrange your own registration with a German health insurer.
It’s usually a fairly straightforward process, and involves taking your passport and residence permit to a regional office and filling out the forms.
There are many German health insurance companies and international health insurers. Factors that might influence your decision are the insurer’s contribution rate, additional services, ease of contact, or availability of English-language information.
Once you’ve become a member, your health insurer will issue you a card (Krankenversichertenkarte), which you’ll need to show each time you visit a doctor or specialist.
GKV maintains an updated list of all state German insurance companies, where you can compare health insurance rates.
Private health insurance in Germany
Who should get private health insurance?
Around one-in-10 residents opt for private health insurance in Germany. Some 40 companies oversee the private medical insurance market. As a result, there are many packages available to suit different budgets.
Whether you’re eligible to switch from a state to private health insurance fund is largely dependent on your employment status.
If you earn less than €60,750 per year (or around €5,063 per month), you must stay on the statutory system.
However, you can choose either state or private insurance if you:
- are self-employed
- are a civil servant
- earn above the salary threshold
- have no basis to join a state insurance scheme
- are a student who renounces their state insurance.
Switching to a private fund isn’t always advisable. Premiums are based on personal factors and prices increase with age, health risks, and added family members.
If you’re young with few health issues and have sufficient income, switching to private insurance is a viable option.
However, if you have serious health issues and have trouble being accepted into a private scheme in Germany, you can opt for a Basistarif. This obliges insurers to accept all cases under the same conditions as the government system.
Membership of an insurance fund typically runs for 18 months. You can usually change health insurance company by giving two months’ notice before the 18-month expiry date, or whenever a supplemental increase has been announced or increased (typically reviewed annually).
Advantages of getting private health insurance coverage in Germany
Private health insurance in Germany typically offers more extensive services and lower waiting times.
However, unlike state health insurance, private insurance does not typically cover children and partners for free.
In addition to more specialist treatments and better accommodation, you’ll have access to doctors who restrict their practices to private patients.
This results in shorter waiting times and you won’t need to make any additional co-payments for medicine. It’s also much easier to find a doctor who speaks your language if you have private insurance.
How does private health insurance work?
While contributions to state health insurance are based on your income, private health insurance contributions are based on your risk profile. This includes your age and medical history.
If you choose to take the private route, you’ll typically pay doctor’s fees upfront and then ask for reimbursement later. Unlike state healthcare services, there is the prospect of being out-of-pocket for a while after any treatment.
However, you’ll usually get a full reimbursement, unlike in state healthcare where you normally pay part of the costs.
Typically, you can choose the level of your excess or deduction fee, where you opt to pay up to a certain amount each year (Selbstbehalt)for your treatments.
Choosing a higher excess for private health insurance is one way to reduce your monthly contributions.
There is also no obligation to stay with a company for 18-months, although the insurance company may have conditions.
Private health insurance companies in Germany
There are a number of private health insurance companies operating in Germany. These include large multinational insurers as well as local German providers, offering full and supplementary policies. German health insurance providers include:
Health insurance costs and reimbursements
German social security contributions cover healthcare costs, and around 120 insurers are responsible for administering state healthcare access.
In 2019, the state healthcare contribution is 14.6% of net income. Generally, you’ll pay around half of this amount (around 7.3% up to a maximum monthly income of €4,538). Deductions from your salary are automatic.
Your employer covers the remaining fee, at a cap of 7.3%.
In addition, state German health insurers charge an additional contribution rate, which can fluctuate year-to-year depending on healthcare expenditure.
The contribution rate varies between insurers (from around 0.3–1.%), and it is payable by the employee based on a percentage of their income. Your insurance fund must notify you of any changes to their contribution charges.
While some insurers have millions of members and others only have a few thousand, their service is unlikely to differ greatly. Each insurer must meet the government’s minimum regulations for healthcare.
The additional contribution rate, however, is one factor to consider when choosing a German health insurance company.
Co-payments for German healthcare services
The German health insurance system has come under pressure to cut healthcare costs in recent years.
Co-payments have been increasing for certain treatments and medicines; they are likely to increase in the future. In some areas such as dental, orthodontic treatment, and optical care, state health insurance only covers a small portion of the cost.
Away from the more specialist areas, state healthcare policies cover most types of medical treatment. This includes GP visits, hospital care (inpatient and outpatient), medical treatment, x-rays, sick leave, mental health care, rehabilitation, prescription drugs, and giving birth in Germany.
In some cases, you may be subject to a co-payment (Zusatzzahlungen) towards the costs of treatment and prescription drugs.
For each quarter of the year you seek medical help, you’ll need to pay a one-off charge of €10. If you don’t require medical assistance, you won’t have to pay this charge.
Nursing costs in Germany
In addition to the 14.6% premiums paid for state healthcare, you must also join the state nursing care scheme (Pflegeplichtversicherung). This covers the costs of meeting any necessary nursing needs (e.g., bathing or feeding if disabled).
In 2019, the contribution rate starts at 3.05% of your gross salary, or 3.3% if you have no children, up to a maximum of €150 a month. Your employer pays up to €69.
- How to choose between local or expat insurance
- Ministry of Health: call 030 340 60 66 01 for information on health insurance.
- GKV Spitzenverband: the head organization for state health insurance.
- PKV Association: the head organization for private health insurance (German).
- Germany social insurances and benefits
Information on health insurance for foreign students: www.hiffs.de and deutscheinsurance.com.