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. 🙂

health insurance in germany residence permit

 

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.

 

    • 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.

 

    • 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.

 

    • 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 270€ 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. (A German friend once told me “ If I have enough money to pay rent, transport, and Krankenkasse, I’m on safe side.”)

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.

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.

141 Comments

  • Reply Sonja Kohlöffel 06/12/2017 at 19:46

    Hi Bastian,

    I recently moved to Germany with my two sons 8 and 13,I immediately registered myself in the town I am living in and told them I do not yet have employment. I then proceeded to the AOK to register with them they told me I cannot register with them as I am unemployed and should therefore register with a private krankenkasse.. is there no possible way to register with a staatliche krankenkasse? I am in desperate need of some answers as I can’t let my boys not have any medical cover 🙁
    I hope you can help me

  • Reply Andra 21/11/2017 at 13:43

    Thank you very much for all the information!
    What I did not understand is that the health insurance is mandatory, even if I do not work/ study. I just moved in Munich, and I did not find a job yet. Should I search for an insurance company?
    Thank you in advance!

  • Reply Alex Federolf 09/11/2017 at 22:41

    Dear fellows, I’ve just arrived to Berlin directly from Brasil and I’m struggling to choose the best Krankenkasse for me and for my wife.
    The thing is, we’re both Brazilian and both European citizens with passports, (I have the German one) but both never lived here before. And we are currently unemployed. Which one should we chose? where to go? who can be kind and guide us through this bureocratic hole?

    • Reply Bastien - Settle in Berlin 10/11/2017 at 10:15

      Hi Alex, my recommendation is to always stay with a public Krankenkasse as it is the cheaper option in the long run for a similar service. TK or AOK is often said to have good customer service.

    • Reply Shane O'Reilly 15/11/2017 at 17:31

      Hey Alex, I’m Irish and my wife is Taiwanese. I was wondering what Visa you arrived on? I am trying to organise things here for a move.

  • Reply Agnieszka 09/11/2017 at 01:30

    Hello,
    Thank you for this website & information.

    Apologies if this has already been covered. It is very easy to get confused with all the details online.

    My situation:
    Polish born, left Poland when very young with parents & now living in Australia. I had my Polish citizenship re-instated recently.
    I am in the process of obtaining my Polish passport, with purposes to be able to relocate to Europe (Germany) arriving on my Polish passport as part of the EU.
    What are my options for general/emergency healthcare whilst I am in Germany (ie. break a bone, dentist cover, injury) & unemployed for the time when I am searching for work?

    • Reply Bastien - Settle in Berlin 09/11/2017 at 21:44

      Hi Agniezska. The first few weeks (or even months), you will be on your Australian insurance or travel insurance if you get one. If you can’t find work early enough before your coverage runs out, then you might have to switch to unemployment benefits to cover healthcare (ALG 2).

      • Reply Agnieszka 10/11/2017 at 04:02

        Hello Bastien,

        Thank you for your reply. I still feel slightly in the dark about the whole situation, as my case appears to be different from others (perhaps?).
        I currently have Private Health Cover in Australia. And it would be easy for me to obtain Travel Insurance.
        However entering Germany on an Australian Passport will mean that I can only remain in Germany for 90 days, pressure to find any type of job in Germany, whereas I would like to continue with my career (Medical Scientist).
        If I arrive on my Polish Passport, I will have freedom of movement as an EU citizen.
        What options do I have?

        • Reply Bastien - Settle in Berlin 10/11/2017 at 10:16

          Well then use your Polish passport and use your Australian coverage, why not?

  • Reply Adrian 06/11/2017 at 09:34

    Hi Bastien. Your site is an amazing find, full of information. Thank you so much! Can you please help me with my situation as I can’t really figure things out? I am a EU citizen and I recently started subletting a room in an a flat in Berlin. I will spend about 3 weeks in Germany every month. I plan on moving fully here in the next 6 moths. For the moment I am working remotely for my company back home.
    I would like to register for Anmeldung in the WG I live, in order to be able get SCHUFA and a bank account and rent a flat. Since I am not paid by a German company and I don’t live here permanently, after I get the Anmeldung do I have to start paying health insurance or am I covered by my the health insurance in my (EU) country?

    • Reply Bastien - Settle in Berlin 06/11/2017 at 19:01

      Hi Adrian, as long as you are working for this foreign company and they cover your health insurance costs through your home country’s system, you will be fine.

  • Reply matt 27/10/2017 at 18:45

    Hi Bastien, thanks for your post. I am due to move to Berlin and start a (low-pay) 6-month internship, and was going to bill the company as a freelancer. But now I have read that maybe I would have to pay around 350 euros per month to get health insurance if I do this (which is too much). What would you recommend? Do I have to be a proper employee to pay less for health insurance? (p.s. what about something like Mawista? Is this still an option?)

    Thanks a lot.

    • Reply Bastien - Settle in Berlin 28/10/2017 at 15:56

      Hi Matt. As mentioned in the post; if you are an employee, then health insurance is covered entirely through your salary. As a freelancer registered in Germany, you’d probably pay around that amount indeed. Mawista is not a Krankenkasse and is only suitable in certain cases for visas limited in time.

  • Reply Lu 18/10/2017 at 12:30

    Thanks for all the information!
    I have been living an working in Berlin since August and only just getting around to getting my health insurance. In this time I have received loans instead of my salary as I have not yet been added onto the payroll. Now when applying for my health insurance should I put the date I started working or the current date for ‘I’d like to become a member as of’? Thank you in advance 🙂

    • Reply Bastien - Settle in Berlin 20/10/2017 at 19:00

      Hi Lu. The first day you started working for them.

  • Reply Krystal Lumbreras 11/09/2017 at 17:18

    Thank you for the information! 😀

    I just arrive to Muenchen, and the insurance from TK is 90 euros, Do you know which intitution has the fee of 81?
    Also, if you can compare the different Public Health Insurances Institutions, Which do you pick up? Are there many differences between them?

    Thank you again!

    • Reply Bastien - Settle in Berlin 11/09/2017 at 19:16

      Hi Krystal, as mentioned in the article, there are no big differences between public Krankenkasse.

  • Reply mary 08/09/2017 at 02:26

    Hey! Thanks for this information. However, I am confused about something. I’ve been a student in Berlin for 2 years, and am about to apply for the “Residency for university graduates looking for employment” category of visa. Till now, I’ve been covered by a private insurance company, which should end in October 2017 officially (since I will no longer be a student after that). My appointment at the Ausländerbehörde Berlin, is in the mid of September. As one of the documents required at the Ausländerbehörde is a proof of health insurance, I’m wondering if my current one will cover that issue. If not, do I have to get another health insurance on my own? Or first get a job and hope for them to handle my health insurance? I’m really confused, so any help would be super!

    • Reply Bastien - Settle in Berlin 08/09/2017 at 11:01

      Hi Mary. Those in-between situations are always confusing. I’m no expert on visa issues but i believe that in your case, the best case scenario would be to have a job which would cover your health insurance yes. In all cases, you need a coverage that is recognized by the German state. If unsure, it maybe best to call the foreigners’ office directly.

  • Reply sary 30/08/2017 at 17:53

    Thank you very much for such a helpful website, My question is : I have in Jun quitted my job and now the insurance company have sent me a message that I should pay for last month, apparently the company I was working for didn’t stop the insurance, is that the company’s responsibility or mine?
    should I pay for the last month ?
    Thank you vey much in advance

    • Reply Bastien - Settle in Berlin 31/08/2017 at 12:56

      Hi Sary. The company that employed you is covering your health insurance for the entire time you are working there. Anything after that is your responsibility, should you switch to another company or apply for coverage at the Arbeitsagentur for example.

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