Health insurance in Germany – all you need to know!

Health insurance in Germany is mandatory and the entire system can be confusing for expats.

German health insurance is said to be one of the best health insurances in the world. It is in need of a reform though!

When moving to Germany, you will immediately be confronted with all kinds of regulations, bureaucratic obstacles and, of course, rules. The issue of health insurance is one of them, and please mind the fact that health insurance in Germany is mandatory. The health  insurance system – being in need of a thorough reform, although it clearly has its benefits – is certainly a force to be reckoned with. In order to figure out which choice suits your requirements best, we will provide an overview of all the options involved and which are necessary in order to choose the right health insurance that suits your needs and budget.

„It takes some time to get accustomed to the options of German health insurance. Do not rely on verbal commitments from insurance providers given to you on the phone.“

In case you have not yet informed yourself about the options available, here you go! Do not despair when the entire system sounds a bit confusing at first – it is, even for most Germans. A separate text about further insurances will be following soon. To figure out what suits your preferences and budget best, consider the following options presented about health insurance in Germany in the text. In case you are looking for a Krankenkasse in Germany that fits your needs best, you should look out for one that offers service in English as well. Some bigger ones actually do and are happy to take on international clients. They even offer all kinds of information in English language on their websites.

An overview over health insurance in Germany

Krankenkassen in Germany offer you a member card when you chose the statutory health insurance.

For members of the statutory health insurance in Germany, also known as gesetzlich Versicherte, there is a card to be shown when they make use of medical services.

Germany’s national social health insurance system is actually one of the world’s oldest and it said to be one of the best in the world. Its origins go back to the so-called Sickness Insurance Law. The programme was originally initiated by Otto von Bismarck in 1883 to offer sickness insurance for industrial labourers. Starting with a rate of 10% of labourers two years later, the entire system constantly evolved until today. In 2009, health insurance was made mandatory in Germany, consequently citizens are required to opt for one of two insurances: either statutory health Insurance (GKV = Gesetzliche Krankenversicherung) provided by the government or private health insurance (PKV = Private Krankenversicherung). Consequently, every individual has to make a choice, even if a short-term stay in Germany is intended. No visa will be issued otherwise.

„Please keep in mind that health insurance is mandadory in Gemany. Sooner or later, you have to make a choice.“

The regulations might seem a bit confusing at first. Germany has a social security agreement with countries of the EEA (European Economic Area), so the citizens belonging there can remain insured in their home countries. Not every contractual service might be included in that, so depending on the insurance cover, supplementary insurance might be necessary. The variety of exceptions, rules and regulations  within German health insurance and the related possibilities force residents and expats to take a closer look at the individual options available. Whatever you choose at the end has several pros and cons. As EU countries are free to make their own rules regarding benefits and healthcare services, hence there are certain differences to be expected. So all in all, there are three options: gesetzlich (statutory), freiwillig (optional, with an income of more than about 60k Euros a year or when self-employed) or privat (private).

EHIC – European Health Insurance Card

In case you are a citizen of an EEA country or Switzerland, you can receive medical treatments in any other member state either at a reduced fee or for free. Terms do vary depending on the issuing country. The European Health Insurance Card was invented to let people have access to medical treatment, but it was not issued for medical tourism. Hence, several sorts of dental treatments are not included, but basic treatments for various purposes are granted and, of course, emergency treatments. The EHIC is for temporary stays only.

Statutory Health Insurance (GKV = Gesetzliche Krankenversicherung) in Germany

Statutory health insurance means basic health services for citizens in Germany.

Staturory health insurance is chosen by most citizens in Germany, as it depends on the income or the kind of job contract: civil servants (Beamte) are mostly members of the private health insurance.

Based on the individual income of a citizen, the statutory health insurance in Germany is the chosen insurance for about 85 % of the population. There are roundabout 110 German Krankenkassen which are governed by the state. The statutory health insurance in Germany is often also called national health insurance. In 2019, the general contribution rate for statutory health insurance consists of 14.6 % plus a contribution rate of 0.7 % for the health insurance fund. Half of the entire rate is paid by the employers. Your spouse and children, if they individually do not earn more than 450 Euros a month, are included in your insurance contribution. In case your gross salary exceeds the limit of 60.750 Euros (2019), your mandatory insurance changes into a voluntary membership of your health insurance. You are then free to chose either to remain at your GKV or opt for a private health insurance. Most people remain at the GKV because once you are a member of the PKV, there is no turning back. For self-employed persons running their own business, things are different. The costs the employer covers for clerks for instance must be paid by the freelancer himself/herself. When you earn less though, there is no need to worry: the contribution is based on your income. The major disadvantage is that you sometimes have to face long waiting times for specialists or even physicians to get an appointment with your statutory health insurance in Germany. The overall treatment you get is more or less sufficient, but a lot of things need to be paid for anyway. It is sometimes not a bad option to add on your statutory health insurance with an supplementary health insurance (Krankenzusatzversicherung), for instance a specialized one for teeth. A few larger companies offer extra health benefits for their employees such as a supplementary health insurance, but the majority tends not to.

Health insurance in Germany for au pairs, apprentices and students

In case your country of origin is not a member of the EEA, the only option is a private health insurance for students in Germany. Au pairs benefit from the fact that both the fee for accident insurance as well as private health insurance are paid by the host family.

Private health care in Germany

Private health insurance in Germany is expensive, especially for the elderly.

The monthly fee for your private health insurance depends on your health and age. A range of services await you, but it has its price. Your health will be assessed in detail before you can sign the contract.

The contributions made to statutory health insurance in Germany are based on your income, but private health insurance (PKV) on the other hand is not: the insurance companies will find a fee based on your age, gender and health condition. With a gross salary of more than  60.750 Euros per year, you are free to choose. While the contributions for younger and healthy people may offer excellent value for money and no doubt a superior service, elderly or those suffering from chronic conditions might pay a vast sum of money every month for their private Krankenversichering. Private health care in Germany means instant access to specialists, a lots of benefits that are not covered by statutory health insurance as well as some included extra services such as physical therapy or acupuncture treatments.

„Private health care is mostly for civil servants. In some cases, a Krankenkasse refuse you take you as a customer, so private health care is the only option. The entire system is rather confusing and consists of many exceptions.“

Another issue to consider is the fact that most rates that start quite budget friendly with private health care in Germany increase tremendously over the years. Especially for retired persons, the monthly contribution to private health in Germany care can become a severe financial burden. The rates to be paid in the future are not very predictable and unless you live in very stable financial circumstances for private Krankenversicherung, it is a risky thing when you get older. There is hardly any way back to national health care once you opted for private health care as well! Please also mind the fact that your partners and kids are not included as thoroughly as with statutory health care. Some extra costs are awaiting families as well.

Some things to consider as well – Pflegeversicherung (long-term care insurance)

long-term care insurance Germany is mandatory as well and linked to health care contributions.

Long-term health care in Germany is connected to health insurance. Due to Germany’s demographic issues, the contributions will certainly rise in the future.

The long-term care insurance (Pflegeversicherung) is directly linked to your contribution to health care in Germany. As a part of the Germany social security,  long-term care insurance was invented to cover for citizens who are old and sick. A quick calculation with just some examples of social security contribution in Germany: for a busy freelancer with a decent monthly income of let’s say 5.000 Euros, the contribution to the freiwillig gesetzliche Versicherung can reach up to 635 Euros for statutory health insurance, plus the additional charge of 0.7 per cent most Krankenkassen charge you in addition to the mandatory fee for long-term care insurance with a contribution of 140 Euros. That sums it up to about 800 Euros altogether – and no tax or further mandatory insurance have been paid yet! Social security contributions in Germany are among the highest in Europe. As soon as you earn less, you should immediately tell your Krankenkasse when you are self-employed and send over some prove in order to adapt your monthly fee!