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. 🙂
- Health insurance in Germany: efficient but complex
- The different provider types
- The costs
- Coverage abroad
- How to sign up for public health insurance in Germany
- Taking on a German health insurance for residence permit or other visas
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”. Let’s try to understand how health insurance in Germany works.
The different provider types
There a 3 kinds of health insurance in Germany you can be under: Gesetzlich, Freiwillig or Privat.
This table aims at providing a quick overview. Read on for more details.
|Public (Gesetzlich or GKV)||Voluntary public insurance (Freiwillig)||Private insurance – (Privat or PKV)|
|Who it is for||– Employees earning less than 56k€/year||– Employees earning more than 56k€/year|
| – Employees earning more than 56k€/year|
– People that don’t qualify for public
|Costs||– 14,80 % – 16,30% of gross income||– 14,80 % – 16,30% of gross income||Based on health profile|
|Pros||– 1/2 of costs paid by employer |
– contribution follows your income
– covers household members at no extra cost
|– contribution follows your income|
– covers household members at no extra cost
|– Shorter waiting times|
– Better access to specialists
– Better treatment quality in some cases
– Included extras
|Cons||– Longer waiting times|
– Sometimes only partial treatment coverage
– Sometimes lower priority at hospitals.
|– Longer waiting times|
– Sometimes only partial treatment coverage
– Sometimes lower priority at hospitals.
|– Unpredictable rates long-term|
– Pay extra for partners or kids
|Remarks||Mostly suited for people with a very safe pension plan and income safety net or for people with no other option at the moment.|
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. Typical situation: you will be insured by a public insurance company that your employer will 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 between between 14,80 % and 16,30% of your gross income.
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 people with no income in the household (kids or partner for example), being with the public system is really good because you cover them with your own policy at no extra cost.
Some drawbacks come with it though. Practitioners tend to prioritize private patients over public ones since they get paid better/faster. This induces longer waiting times when trying to get an appointment. 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.
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 whole share directly to your Krankenkasse. This has for the effect to increase your gross salary, since your employer is not paying for you share anymore. 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 Krankenkassen are usually lower than in public ones for a better coverage when you are a young healthy person, but it increases over time based on your health profile.
Indeed, in the public system, the contribution depends on what you earn. In the private system however, the fee depends on your health risks. So the more you age and/or have conditions, the higher the costs will become. Basically, you need to decide for yourself it’s worth the savings.
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 people with no income in the household, you have to pay extra for each them too. Coming back to the public system after being in the private one is also extremely difficult if not impossible for freelancers.
Health insurance in Germany is efficient, but still costly for individuals.
In the public system
As stated earlier, being with the public system means that between 14,80 % and 16,30% of your income will be use to pay for your health insurance in Germany. As an employee, half of it is paid by you, and the other half by the employer. Some figures to get an idea:
- Depending on your Krankenkasse and your income, you usually pay directly or indirectly a minimum of 180€ per month.
- This rate falls down to 70-90€ for students enrolled at a Germany university (aged under 30), depending on a few things.
- As a good earning freelancer in the public system, the bill can even reach up to 602,25 €, the maximum monthly contribution. This corresponds to a monthly earning of 4.125 €.
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.
The biggest companies for public health insurance in Germany are : Techniker Krankenkasse, AOK : Allgemeine Ortskrankenkasse, BKK: Betriebskrankenkasse, IKK : Innungskrankenkasse, LKK : Landwirtschaftliche Krankenkasse, etc…
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.
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 additional household members should be covered.
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.
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.
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.
A useful tip for freelancers when you are 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.
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, 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 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.