Health insurance in Germany

Germany is often praised for having one of the best health insurance system in the world. It may very well be true but it also very complex! I have also struggled to understand it when first arriving here so i thought i’d share my experience in this overview covering the different types, and what to do if you need one of a residence permit. 🙂

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Health insurance in Germany: efficient but complex

In some countries, health insurance is managed by the government as a public service, and in some others it is purely a private service. Germany has a hybrid & interesting system.

The German state has delegated around 300 insurance companies to manage it’s population’s health coverage. They all work under a contract with the state, can be public or private and are called “Krankenkasse”. Now the trick is that you can sometimes choose if you want to insured by a private one depending on your income situation. Let’s try to understand how health insurance in Germany works.

There a 3 kinds of status of health insurance in Germany you can be under: Gesetzlich, Freiwillig or Privat.

1- Public insurance – Gesetzlich (GKV)

Gesetzlich (versichert) also called pflicht(versichert) is most typical coverage as it compulsory for people earning less than 56K€ a year. You have to be insured by a public insurance company that your employer will most likely pick for you if it is your first job in Germany. Your employer will directly take over the payment of the coverage by paying its share and yours through your wage. The rate is set by law at 14.6%.

The good news is that what you pay is directly related to what you earn so if you face a sudden decrease in income, the fee will also decreasing. If you have kids, being with the public system is really good because you can take your kids under your own coverage at no extra cost.

2- Voluntary public insurance – Freiwillig

Freiwillig (versichert) is basically the same at Gesetzlich except that you earn more than 56K€ a year. You will then pay your share directly to your Krankenkasse while your employer adds your half to your gross salary. This can also mean that you are self-employed and choose to stay in the public system, to make use of its advantages, despite the higher costs compare to private coverage.

3- Private insurance – Privat (PKV)

Privat (versichert) means that you choose to insured at a private Krankenkasse provided you earn more than 56K€ a year or don’t qualify for the public system for any number of reasons. The fees applied by private Krankenkasse are usually lower than in public ones for a better coverage if you are a young healthy person, but it increases over time.

Private Krankenkassen have more complex offers than public ones in terms of what get covered and so on, so choose wisely. You also get different advantages like reduced waiting time at the clinic or at-home nurses. However, it does come with drawbacks. If you have kids, you have to pay extra for each them to have them covered. Coming back to the public system after being in the private one is also extremely difficult if not impossible.

Basically, in the public system, the rate depends on what you earn, and in the private system, it depends on your health risks.

The biggest companies for health insurance in Germany are : Techniker Krankenkasse, AOK : Allgemeine Ortskrankenkasse, BKK: Betriebskrankenkasse, IKK : Innungskrankenkasse, LKK : Landwirtschaftliche Krankenkasse, etc…

All in all, depending on your Krankenkasse, you usually pay directly or indirectly minimum 180€ per month to be covered by your health insurance in Germany. The bill can even reach a whooping 500 – 600 € if you are freelancing with decent earnings. I’m coming from a country where social and health insurance is provided for free to all, so it came a bit as a shock the first months as you can imagine.


“If I have enough money to pay rent, transport, and Krankenkasse, I’m on safe side.”

A German friend of mine

A minority of people also decide not to take coverage because they cannot afford health insurance in Germany. However this is illegal and i strongly advise against doing such thing.

Of course when you go home to visit your family and simply go abroad for holidays in Europe, your German health insurance will cover you and giving your reference numbers should be enough to be reimbursed in the end. Be careful though, you will be reimbursed at the rate that is considered normal for that particular treatment in Germany, so while it will probably cover most of the costs, the rest will come from your pocket in some cases.

Health insurance in Germany is efficient, but still costly for individuals.

How to sign up for public health insurance in Germany

There are a number of ways to sign-up once you have made a choice. You could go to one of their offices or download a form on their websites. If you are in a hurry and need a certificate to start working or to apply for a long-term visa, you can sign-up for TK online, in only a few minutes via this form (100% in English).

The Techniker Krankenkasse has consistently been rated the best Krankenkasse for almost 10 years a row. A sure choice. And they are able to offer some guidance in English too, when needed.

Finding the best rates for private health insurance in Germany

Public Krankenkassen offer more or less the same amount of service across the board for roughly the same price. This is however not the case for private Krankenkassen. Think about how internet providers have different plans and different level of services; the market is more complex and more diverse. You need to pay attention, explore the market and pick something that suits your needs. A good place to do that are comparison platforms like TarifCheck or Preisvergleich. It lets you pick options to define what coverage you want. These are:

  • If you want additional coverage like teeth, vision, alternative medicine (Zusatzleistungen)
  • On the financial side, how much deductible you can afford (Selbstbeteiligung)
  • If you have to stop working for a while, when should a daily sickness allowance should kick in, and how much it should be (Krankentagegeld)
  • If you stay at a hospital, do you wish to have a private room, be handled by the head doctor, etc. (Krankenhausleistungen)

If you are an artist, a writer, performer: think KSK

The German government knows it hard to make a living when being an artist. Paying an expensive health insurance on top of everything else is not easy. That’s why Künstlersozialkasse (KSK) exists. If you are able to prove your main occupation is to live from artistic and creative jobs, the KSK will pay half of your current fees every month (only if you are part of the public system). The tricky part is that there is not a clear distinctions between what’s a art job and what’s not so it might be hard to get into it. Some people hire specialists to fill in the paperwork to make sure they tick the right boxes.

Taking on a German health insurance for residence permit or other visas

If you are not an EU citizen and you love Germany so much that you plan to stay to study or for a job, you will need to show that you have chosen an health insurance in Germany. It is required to obtain a residence permit or even enroll in a university. Germany is usually not very good at recognizing non-EU systems so make sure your health insurance is valid for the German system.

For a lot of foreigners applying for a German visa here for all sort of reasons, the solution here will be to sign-up for a German travel insurance provided by a German company. This makes sure that the insurance policy complies with the minimum requirements expected by the authorities. It can be classified as a private health insurance in Germany but for limited stays for up to 5 years.

 

If you want to study in Germany

If you are under 30 and enrolling in a university program in Germany, you have to take on a German public health insurance. This has a lot of benefits and costs only 81€ a month. It doesn’t happen automatically when you register at the university though. You have let the university know which Krankenkasse you picked. This is unfortunately only possible when you have registered an address in the country. If you are not able to join the public system for whatever reason, it is also possible to join a private insurance.

If you are self-employed

If you are running your own show, paying a Krankenkasse with everything else can be major hole in your monthly budget. This is definitely of the drawbacks of the German system; low-earning self-employed people pay a relatively high amount for their health insurance in Germany. If you have been in a public scheme within the E.U recently, you might to choose what is called a Freiwillige gesetzliche Krankenversicherung. This means that you stay in the public system, which is advised for people with kids and spouses.  For others, it is advised to stay with the private system.

I hope this little run-down helped you to understand the German health insurance system and make a better choice for your own coverage. Good luck.

Tip 1 : If you are lost on how to apply to a Krankenkasse and you plan to be a full time employee, you can often ask for help to your colleagues or to any administrative assistant that may exist in your company. They can be very helpful. In reality, you will most likely have to go on the chosen Krankenkasse website and open an “account” there. You will get a document that says that you subscribed to their coverage, you’ll send it to your company and poof ! There you go! Your employer will take care of the rest.

Sources: Ministry of Education & Research, More info on benefits and the state health system on its website here.

236 Comments

  • Reply Mikael 18/03/2019 at 09:29

    Hi Bastien, thank you for this very helpful page. A year ago I registered and got the Meldebescheinigung in order to become a nebenwohner in my girlfriends apartment in Berlin. As I am working in Denmark I spend about half my time there, and the other half in Berlin. I have an apartment in Denmark, where I also have my healthinsurance. I am now considering to look for a job in Berlin, but I am wondering if it will have any consequence that I have been registered here for a year without German insurance? Will it have any backlash, even though I have just been here from time to time as a nebenwohner?

    • Reply Bastien - Settle in Berlin 21/03/2019 at 09:25

      Hey Mikael. Not entirely sure what you mean with Nebenwohner. In your case though, i would probably assume that you were considered a Danish resident since you have a place there + you work there. If so, then you should probably be good.

  • Reply Camila Batista 14/03/2019 at 19:21

    Hello Bastien, thank you so much for this website, it has been my go to for a couple of curve balls life has been throwing at me recently! I’m currently trying to apply for a health insurance, since for the next 6 months I’ll be self employed before starting my masters, but everyone keeps asking me about the E104 Form? Do you perhaps have any information on that? I’ve been studying in Germany for a few years now, and always used my European Health Insurance Card to get a “Befreiung der Krankenversicherungspflicht”, so I almost wonder if maybe I couldn’t keep on doing that?

    • Reply Bastien - Settle in Berlin 17/03/2019 at 18:12

      Hey Camila. You can’t do that anymore since you will be a German resident. Having the E104 will help you get in the public system.

  • Reply Cedric 23/02/2019 at 18:12

    Bonjour Bastien,

    You mention that children can benefit from freiwillig insurance. Can the spouse too? I’ll be working but not my wife when we move to Germany.
    Thanks a lot for the great blog!

    • Reply Bastien - Settle in Berlin 24/02/2019 at 09:39

      Hey Cedric. When they don’t have any income, yes. (Source)

      • Reply Cedric 24/02/2019 at 14:49

        Bastien, merci ! You are correct, I found the answer meanwhile. Your topic has been very useful again! I will opt for TK as they have English service and their prices are fair. The only surprising thing for me is that many insurances do not cover Zahnreinigung/teeth cleaning/détartrage and I have been wondering how much it usually costs to pay for such a basic dental act in Germany, that we do at least once a year in France.

  • Reply Julen 21/02/2019 at 10:54

    Hi There! Thank you very much for this page, it is very useful! I wanted to ask you this: I am living in Berlin for one month now, I have EU passport from Spain and I am currently unemployed and can not pay 200/300 euros per month for health insurance. How should i proceed?

    • Reply Bastien - Settle in Berlin 24/02/2019 at 09:30

      Hey Julen. In this case, it’s quite likely that you’d need to apply for unemployment benefits, ALG1 or ALG2 depending on your eligibility. It would then take over the costs.

      • Reply Julen 25/02/2019 at 13:19

        Thanks a lot for taking the time to reply to me. I’ll check on this further. Gracias!

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