Health insurance in Germany: a most welcome introduction for newcomers

Health insurance in Germany is one of those crucial topics when moving here. As a newcomer, I guess you must feel like I felt back then: a bit confused about it all. It’s totally normal. 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!

Well this confusion ends today. This guide aims at being the best intro around. It based on my research, years of experience, discussions with dozens of newcomers and interactions with industry players. At the end of this lengthy guide (prepare a big cup of tea), you will be able to understand your options, and how to decide which German health insurance policy is best for you.

health insurance in Germany guide for expats

Health insurance in Germany: TL;DR

Here are the main points to take away from this guide (read it all for more details):

  • All German residents must have adequate coverage. That’s the law.
  • The German system is split into 2 types of providers: public & private. Both types provide the same standard coverage (also set by law) but you get better perks & policies with private providers in some areas.
  • Public providers contributions are set by law (between ≈ 14% & 17%) of your gross income. As an employee, this is paid in part by your employer. Any relative without income of their own can be insured for free under your policy. The vast majority of the German population is with public providers.
  • Private providers contributions are set by an assessment of your health risks. As an employee, this is paid in part by your employer. Any relative without income of their own needs to be insured via an extra-paid policy.
  • Students are eligible to special cheaper rates and conditions.
  • Freelancers have to bear all costs on their own. They are the least favored category among all. Artists can apply for special support to cover half the contributions though.
  • Visa applicants can use special cheaper “expat” policies for their initial applications, but should make sure to pick wisely. Not all providers fulfill requirements for the immigration office.

Read on for more details about the system for common profiles & typical “edge-cases” that newcomers face in Germany. There is an FAQ too. If something is still unclear, feel free to ask questions in the comments’ section.

Overview of the German healthcare system

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

The German government delegates around 300 insurance companies to manage its population’s health insurance. They all work under a contract with the state, can be public or private and are called “Krankenkasse”. Let’s try to understand how health insurance in Germany works.

There a 2 types of health insurance in Germany you can be under: public/statutory (Gesetzlich), or private (Privat).

This table aims at providing a quick overview.

Public (Gesetzlich or GKV)Private insurance – (Privat or PKV)
Who it is for– Employees earning less than  64.350 €/year (gross) – Employees earning more than  64.350€/year (gross)
– Freelancers
– People that don’t qualify for public
Costs – 14,70 % – 17,30% of gross incomeBased on a health risk assessment
Pros– 1/2 of costs paid by employer
– contribution follows your income
– covers household members at no extra cost
– Shorter waiting times
– Better access to specialists
– Better treatment quality in some cases
– Inclusive extras
Cons– Longer waiting times
– Sometimes only partial treatment coverage
– Sometimes lower priority at hospitals.

– Unpredictable rates long-term
– Pay extra for partners or kids
RemarksSuited for the majority of usMostly suited for well-earning single people, people with a very safe pension plan, people with no other option at the moment.

Public health insurance in Germany

Gesetzlich(versichert) also called Pflicht(versichert) or GKV is the most widespread regime in Germany with most of the German population using it. This statutory insurance guarantees a standardized coverage set by German law. This latter also dictates how high the contributions should be for the individual, based on their income and personal life situation.

Who should consider this option?

  • Employees earning less than  64.350€ a year. The German statutory insurance is compulsory in this case.
  • Students under 30 currently enrolled in a German university. It only costs 109€ a month. Under 25, it’s even for free if one of your parents is also with a statutory insurance.
  • In most cases, anybody that has relatives with no income of their own at home, as they can be insured with a single policy for free.
  • Older folks who have more health issues, more often.
  • People with serious conditions, handicaps bound to occur more costs over time.

Costs of public health insurance in Germany

Good news: your contributions are directly related to what you earn. If you face a sudden decrease in income, contributions will also be decreasing. The basic contribution rate for public health insurance in Germany is set a 14,6%. The individual Krankenkasse then add another fee on top (between 0,2% to 2,7%) to their discretion. A national average is 15,7%.

As an employee, half of those contributions are paid for by your employer. When you receive your paycheck at the end of the month, you don’t need to pay anything to your Krankenkasse. It’s already been done for you by your employer.

Some typical examples:

  • Minimum contribution: ≈ 180€ per month.
  • Maximum contribution for employees (employee’s share): ≈  400€ per month
  • Maximum contribution for freelancers: ≈ 830€ per month
  • Contribution for students under 30: ≈ 104€ per month
  • Contribution for students over 30: ≈ 180€ per month.
  • Contribution for unemployed people: ≈ 180€ per month. (or free if you are eligible to unemployment benefits)

Do note that people freelancers, mini jobbers, and employees earning more than 62,5K€ can decide to stay with public providers. It’s then called a “voluntary membership” (Freiwillig gesichert).

Benefits

  • For some of us coming from a country with a single national provider, the experience is very similar. You show up at an appointment, give your card, and everything is directly handled between your Krankenkasse and the doctor. There is hardly any paperwork going on and it works very well.
  • Relatives that don’t have their own income can be covered for free, with the same policy and the exact same benefits.
  • There is no bad surprise regarding contributions, it’s always depending on your income. If your job situation should fail, or your income goes down, you are guaranteed the same level of service at a lower price.
  • If you lose your job, unemployment benefits cover will pay for your contributions.
  • Preexisting conditions, chronicle conditions, heavy handicaps have no impact on your contributions. Providers cannot refuse to take you on.

Drawbacks

  • Practitioners tend to prioritize private patients over public ones since they get paid better/faster. In my 10 years with in Germany with public insurance. I never found to be an issue other than longer waiting times, especially with specialists. There is not much different with general practitioners.
  • If you go the hospital it’s also not guaranteed that your case will be followed by the most experienced doctor or that you get a private room, as it’s the case with private coverage usually.
  • Also, expect some treatments to be only partly covered. For example when filling a tooth at the dentist; only the standard filling will be covered and not the higher quality more expensive one. In this case, you’d need to pay extra from your pocket.
  • Depending on your point of view, your current income and health status, you may find it overly expensive. That’s true. But that is also one of the founding principle of welfare: solidarity.

How to chose and sign-up with a public provider?

It’s a common, (dare I say national) understanding that in terms of coverage, all public options are created equal. In your day-to-day life as a patient, it bares no impact whatsoever on how well or how fast you will be treated as a patient. Difference in price is also negligible. Instead keep an eye on quality of customer service, coverage rates for specific treatments you might be interested in (eg; ergotherapy, homeopathy, etc).

There is however a clear consensus among newcomers regarding which company to turn to: Techniker Krankenkasse. The reasons for that are simple: they have been rated the best providers 15 years in a row, they have excellent customer service, and they speak English. I have been with TK for 10 years now, and I can confidently recommend it as the best public health insurance option in Germany.

Need some more convincing? You can read my full review about the Techniker Krankenkasse on this post. However, other providers like AOK, DAK & Barmer are perfectly good contestants too.

Once you have made a choice, you can simply sign-up online. Feather Insurance has partnered up with the most popular public Krankenkassen to provide the fastest on-boarding around. If you are in a hurry and need a certificate to start working or to apply for a long-term visa ASAP, you can sign-up there (100% in English):

It gets better… : )

Private health insurance in Germany

Privat (versichert) or PKV means that you choose to insured at a private Krankenkasse provided you earn more than  64.350€ a year as an employee. It’s also an option for freelancers or for people who don’t qualify for the public system for any number of reasons. Standard coverage provided by private Krankenkasse also regulated by law. Contributions however are determined by a health risk assessment.

Who should consider this option?

  • Healthy single young professionals who earn well, and who are confident it will stay that way for the duration of their stay in Germany. Also, they should be fairly sure that they will only stay a few years in the country (at least, not retire in Germany).
  • Best suited for people with no kids.
  • Best suited for people with a strong retirement plan.
  • Best suited for people that don’t have any other choice. This typically includes:
    • Students over 30 no public Krankenkasse will take on.
    • Freelancers that arrive from a non-EU country.

Costs of private health insurance in Germany

As stated earlier, your rate will be based on a number of factors, including age and desired services and it is not linked to income. To determine the exact amount of your contributions, you will need to go through a lengthy questionnaire to go over your medical history and in some cases, an examination will be needed too. However, here are some ball park figures to get an idea (Those are approximate figures, range of prices vary wildly because of all factors involved):

With no deductible, no limit on dental coverage (monthly fee):

  • 25 years old: 370€ to 570€.
  • 35 years old: 445€ to 700€.
  • 45 years old: 540€ to 795€.
  • 60 years old: 690€ to 1000€

With 10% deductible, dental coverage limited to 1500€/year (monthly fee)

  • 25 years old: 185€ to 265€.
  • 35 years old: 230€ to 325€.
  • 45 years old: 265€ to 370€.
  • 60 years old: 500€ to 740€

Benefits

  • Lower costs short term & mid term (when young and healthy)
  • An overall better access to higher-quality treatments, material & medical supplies
  • Easier and faster access to specialists, senior staff at hospital.

Drawbacks

  • Higher costs long term: the more you age and/or have conditions, the higher the costs will be.
  • Each relative with no income of their own will require an additional paid policy, leading to more costs. This might offset the savings on your own policy.
  • It’s a lot harder to understand offers and terms in a crowded market.
  • Lack of trust, brokers are often tempted to sell you the policy that gets them the highest commission.
  • More paperwork: medical bills are sent and paid by you first. You need to then clear things out with your provider afterwards.
  • Coming back to the public system after being in the private one is also extremely difficult if not impossible for freelancers.

How to chose and signup for private health insurance in Germany

A good analogy to approach your decision making process is to think about internet service providers. They 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 usually are:

  • If you want additional coverage like teeth, visual aids, 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 additional household members should be covered.

However, a price comparison platform doesn’t replace proper guidance about service.

What if I need more guidance to find right policy?

If you need real humans to talk about your precise need and avoid unnecessary premiums, you may want to talk to independent knowledgeable brokers like Feather Insurance. They have been closely talking to foreign nationals that are looking at private options and know exactly how to answer to your issues and situation. And it’s 100% serviced in English. Feather Insurance also offers those benefits, quite unique on the market:

  • Immediate quote (somehow no other broker does this)
  • 24h digital sign up
  • English concierge service (e.g. helping book doctors appointements)
  • Claims super simple via their paperless tool
  • Any time, any question: just book a quick video appointment via the app.
  • Trustworthy: thanks to their business model, they won’t force anyone into taking private insurance, unless there is no absolutely no other choice.

The German healthcare system: a visual allegory. 😉

Useful things to know:

Coverage abroad

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 number 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.

If you are an artist, a writer, performer, creative: 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.

Full post on KSK and the application process this way.

Freelancers when moving from another EU country

In some cases, especially for people who move to Germany to start as a freelancer, a public Krankenkasse might be reluctant to take you on. This because you might need to prove that you contributed to the public system in your home country. This procedure is normalized via the form E104, which you should request from your domestic system, before you leave the country. This form is a statement of your contributions for them to be transferred to the German system.

There is no need to download and fill it in yourself, this is done by your local health insurance provider and then sent to you. It is then your responsibility to communicate this document to your chosen Krankenkasse.

For visa applicants: taking on a German health insurance for residence permits

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, also sometimes called incoming insurance for Germany. 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.

This is a temporary solution to sort out your residence status, most people switch to a local Krankenkasse afterwards.

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  109€ 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 need guidance on how what policy to get in this case, without it costing a leg, you might consider talking to knowledgeable independent brokers like Feather Insurance, who are capable of scanning the market and find the right policy for your edge case. And it’s 100% serviced in English.

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.  If you are eligible for unemployment benefits in Germany, those costs are covered.

For others, it is advised to stay with the private system. In this case, Feather Insurance can help you find the right and fairest policy for your needs too.


Health insurance options for expats Germany – FAQ

Should I pick private health insurance or public health insurance in Germany?

Private health insurance makes sense in only a few cases. One of them is because you are earning so much that your are financially safe forever and your money is best invested elsewhere. The other one is because it’s the only available option you can afford right now in order to make progress during your time in Germany. If you are not in one of those cases, switching to private is simply not worth it.

Do I need to switch to private health insurance if I earn more than  64.350€

It’s an option but not an obligation. You can also stay with public. It depends on your situation. If you stay with public, you will then switch to “voluntary contribution” (Freiwillig versichert). Self-employed people can also choose to stay in the public system, to make use of its advantages, despite the higher costs compare to private coverage.

What is a voluntary contribution to public health insurance ?

Freiwillig (versichert) offers the same coverage and conditions as a normal public policy. However, your employer will no longer bare half of your contributions, but instead will pay a so-called “maximum contribution share”, set at 358,60€. This has for the effect to indirectly increase your net salary, since your employer will be paying less contribution.

Is health insurance tied to employers in Germany?

No. You are free to switch and pick providers of your preference, regardless of the company you are working for.

How much does health insurance cost in Germany?

The unfortunate answer is: it depends. If generally speaking, it can be deemed affordable compared to some other systems in the word, the actual contribution amount is tied to professional situation & income. If you stay with the public system, contributions are set by law at 14,6% of your gross income. If you are with a private provider, contributions are set by an assessment of your health risks. You can read more details in this post.

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 and feel free to leave a comment if you have any questions.

Sources: 1, 2, 3, 4, 5

315 Comments

  • Reply Nidhi Khanwalkar 22/12/2020 at 16:59

    I am trying to understand who pays for medicines that’s your doctor prescribes and can you claim it from insurance.

    • Reply Bastien - Settle in Berlin 23/12/2020 at 20:41

      Hey Nidhi. If you are on public, you don’t pay for anything at the pharmacy at all. Payment is taken care of you in the vast majority of cases. On private, you have to first pay yourself, and then claim the money back.

  • Reply Rachit 09/12/2020 at 23:08

    Hi Bastien,
    First of all, many thanks for creating such a beautiful repository and for covering so many topics.
    I have a couple of questions and hope you can help on the same. To give you a context, My wife and I shifted to Munich from India last month. She has got a job in Munich and I am currently working remotely for an Indian company. According to my understanding, since I am earning (remotely), I am not eligible for a free dependent Public Insurance on my wife’s insurance. As mentioned by you in the blog, I do have a 5 year expat travel insurance. We have applied for the resident permit and are awaiting our appointment. I have two questions:
    1) Will the expat insurance of 5 years be sufficient for the application
    2) Should I opt for a Private Insurance to mitigate the risk and how difficult is the process of moving from Private to Public later

    Thanks.

    • Reply Bastien - Settle in Berlin 10/12/2020 at 09:48

      Hey Rachit. 1) For first time applications, and if the insurance policy satisfy all requirements, it’s enough yes. 2) Talk to an expert (I recommend Feather Insurance because their reasonable and honest counselling) for more detailed info. You can go back to public insurance if you get a full time job here.

      • Reply Rachit Singh 10/12/2020 at 11:15

        Thanks Bastien for the quick response.
        For first time applications, and if the insurance policy satisfy all requirements, it’s enough yes.-Is there published list of requirements which are needed. I can crosscheck and go back to my Expat insurer accordingly.
        Thanks in advance.
        Rachit

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