Health insurance in Germany: the intro you should really read first

Health insurance in Germany is a crucial topic when moving here. As a newcomer, it’s normal to feel a bit lost at first. Germany has one of the most complex healthcare systems in the world!

This confusion ends today. Based on industry experts and years of experience, this guide gives you the best introduction on the topic, written for newcomers in Germany.

At the end of this lengthy guide (prepare a big cup of tea), you will be able to understand your options and decide which German health insurance policy is best for you.


Health insurance in Germany: short overview

Here are the main points to take away from this guide:

  • All German residents must have adequate coverage. That’s the law.
  • The German health insurance system is split into 2 types of providers: public & private.
  • Public providers costs are set by law (14% to 17% of gross income.) If you are 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. 90% of the German population is with public providers.
  • Private providers costs are set by an assessment of your health risks. If you are 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. 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 the sister guides to this main post:

Read on for more details about the system & typical situations newcomers face in Germany. There is an FAQ too. If something is still unclear, feel free to ask questions in the comments’ section.

Bastien
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Public health insurance in Germany

Gesetzliche Krankenversicherung (also called Pflichtversicherung and GKV) is the most widespread German health insurance regime. This statutory insurance guarantees a standardized coverage set by the German Social Act (SGB – Fünftes Buch). This system operates on the solidarity principle, where the active healthy working population contributes to care for the sick & the old.

Who should counsider 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 insurance 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. 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 a quick reference:

  • Minimum contribution: ≈ 109€ per month.
  • Maximum contribution : ≈ 400€ per month (830€ for freelancers)

Employees pay their contributions directly via their payslips automatically. Freelancers and students have to manually transfer those to their provider.

Benefits

  • Going to the doctor is simple. You show up at an appointment, give your card, and everything is directly handled between your Krankenkasse and the doctor with hardly any paperwork.
  • Relatives with no income (spouse, kids) can be covered for free, with the same policy and the exact same benefits.
  • Contributions are always based on your income. If 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 have no impact on your contributions. Providers cannot refuse to take you on.

Drawbacks

  • Practitioners tend to prioritize private patients over public ones. This is because they get paid better/faster. I never found to be an issue other than longer waiting times, especially with specialists.
  • 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. This is the case with private coverage usually.
  • Also, expect some treatments to be only partly covered. Premium tooth fillings are for example not 100% covered.

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

Public options are more or less created equal and you won’t feel a difference 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).

Techniker Krankenkasse is a favorite among foreigners thanks to top ratings & English support. I have been with TK for 10 years now, and I strongly recommend it: Techniker Krankenkasse – A long term review

You can sign-up online to receive a certificate fast, which is useful to start working or to apply for a long-term residence permit ASAP:

Once you sign-up with a public provider, you automatically get a social security number.

My experience with public German health insurance

If you want to know what it’s like to be on public health insurance in Germany, you can read my Techniker Krankenkasse review. It also contains a report of my life as a patient over 10 years, one surgery & 2 births.

In short: only additional waiting times with GPs and specialist is annoying. I never got the impression to receive second-class healthcare/treatment because I was with a public Krankenkasse. I’ve always been happy with the customer service too.

It gets better… : )

Private health insurance in Germany

Privatversicherung or PKV means that you are 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?

You can read here a dedicated post to decide if private is right for you: Switching to private health insurance in Germany: consider this first

  • 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

Costs are not easily assessed because it all comes down your health profile, age and personal situation. However, here are some approximate figures to get an idea:

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€.

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€.

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 with age & conditions. even with old-age provisions (Alterungsrückstellung), which are included in your contributions by law.
  • Each relative with no income will need an additional paid policy.
  • It’s a lot harder to understand offers and terms in a crowded market.
  • More paperwork: pay medical bill first, seek a refund with your provider later.
  • Coming back to the public system is extremely difficult if not impossible for freelancers.

How to signup for private health insurance in Germany

The market is more complex and more diverse. Since contracts are based on your individual preferences, it’s a lot more difficult to compare and pick the right policy. You can read a full guide about this: Picking the right private health insurance in Germany

Talk to independent knowledgeable brokers like Feather Insurance. They are used to talk to foreigners with all manners of cases. Ottonova is also popular with foreigners.

Please note that if you sign-up with a private provider, you need to manually request a social security number from the pension office.


Still undecided? You can read all the differences between private and public healthcare in Germany here.


The German healthcare system: a visual allegory. 😉

Health insurance for employees

Costs are shared between you and your employer and you have a lot of options at your disposal:

  • It doesn’t matter if you go with private or public, you are free to pick your health insurance provider. It is not bound to your employer.
  • Your employer will ask for a membership certificate (Mitgliedsbescheinigung) before you start a job.
  • If you are with public, you don’t need to pay anything to your Krankenkasse. It’s already been done for you by your employer.
  • If you are with private, you pay directly to your Krankenkasse. However, you can also receive tax free allowance from your employer (Arbeitsgeberzuschuss), up to 385€/month. You should inform your employer if you are eligible.

Health insurance in Germany for freelancers

Health insurance for freelancers in Germany can become a major burden. Low-earning self-employed people pay a relatively high amount. Here are the options presented to you:

  • If you have been in a public scheme within the EU recently, you can choose a public Krankenkasse (Freiwillige gesetzliche Krankenversicherung). This procedure is normalized via the form E104, which you should request from your domestic system, before you leave the country. Request this from your old provider and send it in for your new Krankenkasse. You can also go for a private provider too.
  • If you are an artist, a writer, performer, creative: you can join KSK. The Künstlersozialkasse (KSK) will pay half of your monthly contributions. There is sometimes not a clear distinction between what’s a art job and what’s not. 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 this way.
  • In other cases, it is advised to stay with the private system to avoid high costs. In this case, Feather Insurance can help you find the right and fairest policy for your needs too.

German health insurance for visa applicants

Whatever your residence permit is, adequate health insurance is always a requirement.

Getting coverage from a local Krankenkasse is often impossible when you are outside Germany. For this, you will need an intermediate solution to grant you entry into German and get a visa, before switching to a local provider.

Those supercharged travel insurance (also called incoming insurance or expat insurance) have the following characteristics:

  • The insurance policy complies with the minimum requirements expected by the immigration office. Otherwise, your visa might get rejected.
  • It’s only valid for first-time visa application. They are not accepted when renewing a visa.
  • It’s only valid for a maximum of 5 years.
  • It gets expensive if you are older.
  • Coverage is not as a good as with local providers.
  • It’s a stop-gap solution until you have something better in Germany.

Providers like Feather Insurance or Ottonova specialize into those temporary German health insurance solutions that guarantee acceptance from the immigration office.


Health insurance for students

The system is fairly simple in this case:

  • If you are under 30 and enrolling in a university program in Germany, you should probably stick with public health insurance too. 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 over 30 and enrolling in a German university, it’s probably best to pick a private provider. Students over 30 don’t have access to the special student rate.
  • If you are not able to join the public system for any other 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 an exchange student from the EU, your EHIC card will be enough. Not need to have a local provider.
  • If you were with private insurance as a student, it is possible to switch to public again when you start to work in a job.

German health insurance when unemployed

Unemployment benefits in Germany covers the costs of health insurance.

As an employee, your pay into those benefits via your payslip. This safety net includes 60-67% of your net salary, as well as your health insurance costs for the entire duration of your unemployment benefits.

  • If you are with a public Krankenkasse, you just need to notify them that you are unemployed and the rest will be taken care of itself.
  • If you are with a private Krankenkasse, you have the right to cancel your private plan & switch to a public one to lower your costs. You can also decide to stay with a private health insurance provider, the Arbeitsagentur would then contribute to part of the costs

Dental healthcare in Germany

The German healthcare system takes good care of your teeth with trained professionals and up to-date equipment. Basic care is provided as standard by all healthcare providers in Germany:

  • Regular checkups
  • Teeth descaling
  • Fillings with standard material
  • Teeth removal

Other more extensive treatments (such as parodontologie treatments, fillings with premium composites, crowns, dentures implants, etc) are treated differently. Public healthcare companies will cover only 60% to 70% of the costs. Private providers will cover costs based on the agreed contracts.

If you want more detailed information and whether you really need a complementary dental insurance in Germany, feel free to read this detailed post.


Mental healthcare in Germany

Costs associated to psychotherapy for mental illnesses are covered by public Krankenkassen, also if those disorders come from another condition, even physical ones (depression in case of cancer for example). They however only recognize those 3 methodologies:

  • Behavioral therapy
  • Analytical psychotherapy
  • Depth psychology therapy

Up to 300 sessions can be covered by public german health insurance, depending on the methodology.

Private Krankenkassen may chose to cover other methodologies/therapies than the ones listed above. Look closely at the extent of coverage you have in the package/plan you book.


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 introduction helped to understand health insurance in Germany and make a better choice for your own policy. Good luck and feel free to leave a comment if you have any questions.

Bastien

Sources: 1, 2, 3, 4, 5, 6, 7