The German healthcare system: a complete guide to accessing healthcare in Germany, including information on health insurance in Germany (private and public), hospitals in Germany, visiting doctors, emergency services and more.
Under the German healthcare system, if you’re a resident living and working the Germany, you may be eligible for state healthcare in Germany, provided you are registered with state health insurance in Germany. Otherwise you must typically be covered by private health insurance in Germany.
This guide explains how to access the German healthcare system:
- German health care system
- German health insurance scheme
- How to register for healthcare in Germany
- Getting your German healthcare card
- German healthcare for European citizens (EHIC card)
- Doctors in Germany
- German healthcare system fees
- Hospitals in Germany
- Pharmacies in Germany
- Going to the dentist in Germany
- Pregnancy and Birth in Germany
- Emergencies in Germany
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The German healthcare system
The German healthcare system dates to the 1880s, making it the oldest in Europe, while today its doctors, specialists and facilities make it of one the very best healthcare systems in the world. Today it operates under a dual public-private system.
The healthcare system in Germany is funded by statutory contributions ensuring free healthcare for all. You can also take out private health insurance (Private Krankenversicherung or PKV) to replace or top up GKV cover. There are strict conditions, however, about who must register for mandatory state health insurance, and who can opt out in favour of private health insurance.
Travellers who have a foreign health insurance policy can use it during temporary visits to Germany, but will typically be asked to pay in cash at the end of their visit and claim a reimbursement later. If you are from the Eureopean Union (EU), European Economic Area (EEA) or Switzerland and staying only temporarily, you may use your EHIC card. Once you become an official resident, you will typically have to take out compulsory German health insurance.
The German health insurance scheme (GKV)
If you are an employee and you earn less than €57,600 a year (€4,800 a month in 2017), you have to take part in the government health scheme – Gesetzliche Krankenversicherun or GKV – taking out health insurance as soon as you’ve signed your work contract.
The scheme is administered by around 110 Krankenkassen, non-profit making associations who must all charge the same basic rate of 14.6% of your eligible gross salary, up to a maximum of €4,350 a month in 2017 (€52,200 annually). You don’t pay more than this even if your income is higher. This amount is shared equally between you and your employer. You have to stay with a particular Krankenkasse for 18 months, after which time you can switch to another government scheme. Employed workers only pay contributions if they earn over €850 per month.
GKV covers you for primary care with registered doctors, hospital care (both in- and out- patient) and basic dental treatment. Non-working dependents living at the same address and registered with the Krankenkasse are covered at no extra cost.
You can register with any Krankenkassen. Some, like AOK, BEK and DAK have millions of members; others have only a few thousand. They must all adhere to government rules on the minimum cover they offer. Employers usually organise your health insurance but you can do it yourself. Check out the rates and conditions offered by different state insurers here.
Under the mandatory healthcare system in Germany, you and your dependents must also become members of the government long-term nursing care scheme (Pflegepflichtversicherung), which covers some of the cost of personal care should you become disabled. In 2017 the rate was set at 2.55% of your gross salary (or 2.8% if childless), up to a maximum of €110.93 per month (or €121.80 if you have no children), of which your employer pays half.
Private healthcare in Germany
You can choose to opt out of the state insurance plan and take out private health insurance cover (Private Krankenversicherung or PKV) if you are:
- an employee earning more than €57,600 (2017);
- working part-time and earning less than €450 a month;
- a freelance professional;
- an artist;
- a civil servant or certain other public employee.
PKV usually covers a much wider range of medical and dental treatments than GKV. Companies offer different levels of cover, premiums depend on age at entry into the scheme and any pre-existing conditions and cover is usually per person rather than per family as with the government insurance schemes. Part of medical insurance premiums is tax-deductible.
Employers in Germany also contribute to private health insurance fees, up to a maximum of €317.55 per month.
If you’re not eligible for state health insurance, you can opt to take out private health insurance from a local or expat health insurance company. Some of the largest international health insurers include:
The PVK maintains a full list of private German health insurance companies.
Healthcare system in Germany: How to register
Based on German healthcare legislation, if you live in Germany long-term or work in Germany, you must register with the German authorities at your local town hall (Einwohnermeldeamt). Once you are registered, have a social insurance number (Sozialversicherungsnummer) and you’re making national insurance contributions, you are entitled to state-run healthcare the same as German nationals.
In order to access this, you also have to register with a health insurance fund. See rates offered by different state insurers here. A non-working spouse and children are covered by the same insurance.
German healthcare system: Health card
Your insurer will give you a health insurance card (Krankenversichertenkarte), which you have to take with you each time you visit any doctor, dentist or specialist in Germany. Since 2014 an electronic eHealth card with a photo of the holder (unless under 15) is proof of entitlement to medical services and benefits. The card, which contains your name, date of birth, address and health insurance data, is scanned when you visit a medical service.
EU/EEA and Swiss citizens: European Health Insurance Card
If you already have an European Health Insurance Card (EHIC) you can get free medical treatment in Germany while you are in the country temporarily. The patient contribution (or co-payment) is not reimbursable. Once you take up official residence and/or employment you are no longer covered by the EHIC and must take out German health insurance and get a Krankenversicherungskarte (health insurance card).
If you don’t have an EHIC and are not paying German national insurance you must take out private health insurance – or pay the full costs for any medical costs you incur.
Doctors in Germany
Doctors are called Ärzte; a Hausarzt is the equivalent of a GP or primary care doctor. Under the German healthcare system, you are free to choose your own doctor. Many speak at least basic English. Some doctors only treat private patients, so if you have state insurance make sure to check beforehand otherwise you will have to pay for treatment.
Doctors who treat patients as part of the statutory health scheme must be registered with the Association of Statutory Health Insurance Physicians or Kassenärztliche Vereinigung. Look for a sign in the surgery saying Kassenarzt or Alle Kassen. You can find a doctor through a personal recommendation, your embassy, the Gelbe Seiten (yellow pages), on the Weisse Liste (in German) or on this online English language directory.
Practice hours are usually from 8am–1pm and from 3pm–6pm from Monday to Friday; many are closed on a Wednesday afternoon. Few practices are open on Saturdays and only emergency services operate on Sundays.
Some doctors have an ‘open door’ policy where you can just turn up at the surgery but be prepared for a long wait. Others operate an appointment system, so you’ll need to phone the practice beforehand. If it’s urgent then you will be given an appointment immediately or on the same day; if it’s not you may have to wait for a few days or even weeks.
Don’t forget to take along your health insurance card to your appointment.
German healthcare fees
If you have state insurance, the practice will send the bill direct to your health insurer; if you have private insurance, you will typically pay upfront and be reimbursed by your insurance company later. Everyone has to pay a fee of around €10–15 in cash for their first visit every quarter (private patients can reclaim this).
Hospitals in Germany
Hospitals are called Krankenhäuser. There are three main types:
- public hospitals (Öffentliche Krankenhäuser) which are run by the local and regional authorities;
- voluntary, non-profit making hospitals (Frei gemeinnützige Krankenhäuser) run by churches or organisations run by the German Red Cross;
- private hospitals (Privatkrankenhäuser).
You will need to be referred to a specialist in a hospital by your GP. You should take your EHIC or German health insurance card when you visit. You have to pay a fixed charge of around €10–15 per day, up to a maximum of 28 days in a year. If you are under 18 years old you do not have to pay.
If you’re going to be an in-patient, note that hospitals have a certain amount of space allotted to patients with public insurance and for those with private insurance.
If you have a ‘private’ room it means covered by private insurance rather than room for your use only; these private rooms are generally used for two patients who are separated by a curtain. Take your own soap and personal items.
Pharmacies in Germany
Pharmacy opening hours
Pharmacies (Apotheke) are open 9am–6pm from Monday to Friday and 9am–12pm on Saturdays. They all provide addresses for services outside of opening hours.
Medication does not always come with dosage instructions on the package. Make sure you ask your doctor when and how much you should take and write down the information so you have it later. Sometimes your pharmacist will also be able to tell you about dosages but they are less likely to speak English; if your German is not good, it’s easier to get information you need from your doctor.
Check here for information about local on-call pharmacies.
Prescription medication is sold in Germany by company name, not by the active ingredients in them (as they are in the US, for example). Doctors may prescribe expensive medication options, so ask if there is a cheaper medicine available with the active ingredients you need.
You can take a prescription from your GP to any pharmacy. If the prescription is on a pink slip of paper, you will have to pay a non-refundable fixed charge (around €5–10). You have to pay the full cost for certain medications for minor ailments like cough mixture.
If you have private insurance, you will most often get prescriptions on a blue sheet of paper, which means you have to pay the full price of the drug up front and then send the receipt to your insurance for reimbursement.
Visiting the dentist in Germany
You can find a dentist (zahnärzte) who operates within the statutory health insurance scheme on the KZBV website (in German). Otherwise, when you visit a dentist look for a sign saying Kassenarzt or Alle Kassen which means that the dentist operates under the state German healthcare system. Children and young people up to the age of 18 do not pay for dental treatment.
Check with your insurer about what is and isn’t covered as the state insurance has limited cover and even private insurers won’t fully reimburse for all treatments – and dental costs in Germany are extremely high.
Pregnancy and birth in Germany
The ‘morning-after pill’ or RU487 is widely available in Germany (weekdays you can get a prescription from a gynaecologist and at weekends through a hospital), although some Catholic hospitals won’t administer it. Go to the A&E or ER in the first instance.
Pregnancy tests (Schwangerschaftstest or B Test) are available in pharmacies (Apotheke), but you have to ask for them at the counter.
If you’re pregnant, visit a gynaecologist (Frauenarzt/Frauenärztin) or doctor to confirm the pregnancy. After the initial consultation, you’ll be given a Mutterpass which records all the medical procedures and your state of health throughout your pregnancy. You’ll need to inform your health insurer of the pregnancy: statutory insurers will cover all the costs of the maternity and birth while private insurers may not, so check.
For more information on pregnancy and giving birth in Germany, see our guide to having a baby in Germany.
German healthcare system pros and cons
Germany’s healthcare system sits between the British state-run and the American market-led model, relying on a dual public-private system. Before you consider the positives and negatives of the German healthcare system, expats need to consider whether public insurance or private health insurance is required.
In particular, self-employed, elderly residents, long-term students and high-earners will have to weigh up the positives and negatives of public and private healthcare in Germany, as they are eligible to opt out of Germany’s mandatory public health insurance.
German healthcare system pros
- Under the German healthcare system, you are not restricted to the nearest GP in your postcode. Patients in Germany are able to choose from a wide range of doctors, hospitals and remedies.
- Patients are not expected to first see their doctor in Germany before being referred to an alternative healthcare professional. If you wish to see a chiropractor you can do so without a doctor’s referral.
- Germany’s private health insurance sector is well developed with plenty of choice. Private health insurance is available from more than two dozen German health insurance companies, including charity and church-run hospitals, as well as private centres.
- Students qualify for special benefits under the German healthcare system; certain EU students will be able to use their European Health Insurance Card if they have insurance in their home country, while non-EU students under 30 qualify for a discounted monthly rate (around €80) for German health insurance, valid up to their 14th semester.
- Germany offers self-employed artists, writers, journalists and musicians a specialised health insurance group known as the Künstlersozialkasse (KSK). This state-funded health insurer essentially acts as an employer by paying half of your insurance for pensions, health and nursing care.
- Germany’s state health insurance contributions are based on income, however, benefits are distributed according to need. While private insurance fees are based on your risk – meaning younger people can pay less, for example, but not necessarily someone with a serious illness – coverage can be more beneficial as it depends on what’s in your contract.
Cons of the German healthcare system
- Some have raised concerns about the potential impact of the dual system (private and public) on the quality of care patients receive, with the likelihood that doctors with more training and experience will move to the private sector where there are higher income earners.
- Patients who are required to stay overnight in hospital are charged additional fees, including meals. Many insurance companies do not cover these costs.
- Some private health insurers don’t accept expatriates until they have been a registered resident in Germany for at least two years.
- The higher your taxable income is in Germany, the more you are expected to pay for your statuory health insurance.
German healthcare statistics
- Germany has the highest level of healthcare expenditure in Europe, as well as ranks among the top European countries for the largest percentage of GDP spent on healthcare (at just over 11% of GDP), along with France, Sweden and the Netherlands. This amounts to around €3,500–4,000 spent per inhabitant, although around 80 percent of Germany’s healthcare costs are funded by compulsory health insurance and other schemes.
- Germany also spends the most in Europe (4.9%), second only to France (6.1%), on healthcare administration and governance.
- WHO estimates the amount of healthcare professionals in Germany at around 36 physicians, 111 maternity personnel, 8 dentists and 6 pharmacists per 100,000 inhabitants.
- Hospital patients are often considered to have a more ‘relaxed’ stay in Germany. Doctors and nurses are said to have an informal bedside manner due to reduced pressure to follow rules sometimes seen in centralised healthcare systems, such as the NHS in the UK. For example, stays in German hospitals ranked at an average of 7.6 days in 2014, the third highest in the OECD.
In an emergency
For urgent medical treatment, go to the A&E or ER which are called Notaufnahme. Emergency services are covered by both state and private health insurance. If you need an ambulance, call the pan-European number 112 free of charge. The fire brigade ambulance service (Rettungswagen) will take you to the nearest hospital. Call 19 242 to find an emergency doctor, 116 117 for a non-emergency doctor on call, or phone your surgery for details of their out of hours service. You can save this full list of emergency numbers in Germany.
German healthcare system: useful phrases
- I need an ambulance – Ich brauche einen Krankenwagen.
- Heart attack – Herzinfarkt
- I need a doctor – Ich brauche einen Arzt.
- I need a hospital – Ich brauche ein Krankenhaus.
- There’s been an accident – Es gab einen Unfall.
- I am allergic to… – Ich bin alergisch gegen…
- Hospital – Krankenhaus
- Patient – Patient
- Sick – Krank