Insurance

Understanding Germany Healthcare System & Health Insurance

Published

8 months ago

February 2, 2024

Germany is well-known for its excellent healthcare system, which prioritizes comprehensive coverage and accessibility for its residents. Health insurance, which is required for all citizens and residents, is central to this system, as it ensures that individuals have access to quality medical services without incurring excessive expenses.

If you intend to relocate to Germany, you must first understand the country’s health insurance system and enrollment requirements. Health insurance, which is mandatory in Germany, is a fundamental aspect of life and is required to access healthcare services.

How Does the German Healthcare System Work?

Mixed public-private healthcare is used in Germany. It is based on mandatory health insurance, which is either statutory or private. Statutory health insurance (Gesetzliche Krankenversicherung) is required for employees below a certain income threshold, while self-employed and higher-income earners can buy private insurance (Private Krankenversicherung).

Both types of insurance cover primary care, specialist consultations, hospitalization, prescriptions, and preventive care. Government, employer, and employee contributions fund the system. Preventive care and patient education are prioritized, and patients can choose their doctors.

Side note: Did you know that the German health care system covers more than 80% of the pharmaceutical costs of its residents, making it the second most generous in the EU after Luxembourg?

What Is Statutory Health Insurance (public health insurance)?

Germany requires most people to have statutory health insurance (Gesetzliche Krankenversicherung–GKV). Statutory health insurance is solidarity-driven because all members pay a percentage of their income. Income-dependent contributions are split between the employer and employee. This makes healthcare affordable for all income levels.

Statutory health insurance covers primary care, specialist consultations, hospitalization, prescription drugs, and preventive care. Essential treatments, procedures, rehabilitation, and long-term care are covered.

However, higher-income earners and self-employed people can choose private health insurance instead of statutory health insurance.

A public German health insurance Company

Who Is Eligible?

The following categories are legally required to be covered by German statutory health insurance:

Employees whose income falls below a certain threshold (currently around €69,300 per year in 2024). This includes both full-time and part-time employees.
Students up to the age of 30 who are enrolled in state-recognized educational institutions and do not have regular income exceeding the income threshold. Different rules may apply after the age of 30 or upon completion of studies.
Individuals undergoing vocational training, such as apprenticeships.
Family members of individuals covered by statutory health insurance, such as spouses and children.

What Does It Cover?

The services mentioned below are legally mandated to be included in statutory health insurance coverage in Germany:

Primary care	General practitioner (GP) consultations, check-ups, and basic medical treatments.
Specialist care	Consultations and treatments provided by medical specialists, such as dermatologists, cardiologists, or gynecologists.
Hospitalization	Inpatient treatment and care in hospitals, including surgeries, diagnostic procedures, and rehabilitation services.
Prescription medications	Medications prescribed by healthcare professionals, subject to reimbursement regulations and coverage restrictions.
Preventive care	Preventive screenings, vaccinations, and health promotion programs aimed at early detection and prevention of diseases.
Maternity and childbirth	Prenatal care, delivery, and postnatal care for expectant mothers.
Rehabilitation	Rehabilitation services, including physiotherapy, occupational therapy, and speech therapy.
Mental health	Outpatient and inpatient treatments for mental health conditions, including therapy and psychiatric care.
Medical aids and devices	Coverage for necessary medical aids, such as prosthetics, orthotics, hearing aids, and mobility aids.
Dental care	Basic dental treatments include check-ups, cleanings, fillings, and extractions.

What Is Not Covered?

The following medical services are usually not covered by statutory health insurance or are partially covered:

Certain dental treatments	Extensive procedures like orthodontic treatment or cosmetic dentistry may not be fully covered by statutory health insurance and may require the patient to fully or partially pay for the services.
Alternative and complementary therapies	Public health insurance may not fully cover services like acupuncture, homeopathy, or naturopathy. Still, some insurance funds may offer partial coverage for specific alternative therapies.
Private hospital rooms	While public health insurance covers necessary hospitalization, opting for a private room or additional amenities in a hospital may require out-of-pocket expenses.
Non-prescription medications	Over-the-counter medications are generally not covered by public health insurance. Still, reimbursement regulations and coverage restrictions cover prescription medications prescribed by healthcare professionals.
Certain medical aids and devices	Basic medical aids such as prosthetics, orthotics, or hearing aids are covered. Still, some specialized or high-end devices may require additional coverage or out-of-pocket expenses.
Cosmetic procedures	Cosmetic surgeries or treatments performed for aesthetic purposes are typically not covered by public health insurance.

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How Much Is It?

The cost of public health insurance in Germany is typically calculated as a percentage of an individual’s income and, as of 2023, ranges from 14.6% to 15.6%, depending on your salary. This percentage is split between you and your employer, but if you are self-employed, you bear the entire cost yourself.

Some public health insurance companies in Germany charge the following premiums for an individual earning €3,900 per month:

Health Insurance Provider	Contribution rate 2023		Supplemental Rate 2023
	Percentage (%)	Euros (€)	Percentage (%)	Euros (€)
TK	14.6%	€570	0.70%	€27
BARMER	14.6%	€570	1.10%	€43
DAK Gesundheit	14.6%	€570	1.50%	€59
AOK Bayern	14.6%	€570	1.10%	€43
IKK classic	14.6%	€570	1.00%	€39
KKH	14.6%	€570	1.50%	€59
KNAPPSCHAFT	14.6%	€570	1.10%	€43
SBK	14.6%	€570	1.30%	€50
BKK Mobil Oil	14.6%	€570	1.10%	€43
Audi BKK	14.6%	€570	0.70%	€27

What Is Private Health Insurance (Private Krankenversicherung)?

In Germany, private health insurance (PKV) is an alternative to mandatory health insurance. It is a voluntary form of coverage available to people who are not required to have statutory health insurance, such as higher-income earners, self-employed people, civil servants, and certain professional groups.

Private health insurance works on an individual contract basis, allowing policyholders to create customized agreements with specific private insurance providers. Private health insurance premiums are typically determined by factors such as age, health status, and desired coverage, with younger people often benefiting from lower rates. Private health insurance provides comprehensive coverage, including additional services, alternative treatments, and access to private hospitals or specialized medical providers.

Who Is Eligible?

The following categories are eligible for coverage with private health insurance in Germany:

Individuals exceeding the income threshold set for mandatory statutory health insurance.
Self-employed individuals, including freelancers and entrepreneurs, regardless of their income.
Students above the age limit for mandatory statutory health insurance (typically 30 years old) or who have private insurance as dependents of their parents.

What Does It Cover?

The following are usually covered by private health insurance:

Consultations and Examinations	Private health insurance often cover a wide range of medical treatments, including consultations, examinations, and diagnostic procedures. Both general practitioners and specialists can conduct these.
Surgeries and Hospitalization	Private health insurance typically provide coverage for various surgical procedures, both elective and necessary, as well as hospitalization costs for inpatient care. This includes access to private rooms or enhanced hospital accommodation.
Prescription Medications	Private health insurance policies generally include coverage for prescription medications prescribed by healthcare professionals, subject to the terms and conditions of the specific policy.
Dental Treatments	Depending on the policy and chosen coverage options, private health insurance may offer coverage for various dental treatments, including preventive care, fillings, extractions, and more extensive procedures.
Alternative and Complementary Therapies	Some private health insurance plans cover alternative and complementary therapies, such as acupuncture, homeopathy, or naturopathy, depending on the policy and specific coverage.
Additional Benefits	Private health insurance policies may offer additional benefits such as coverage for travel vaccinations, preventive screenings, health check-ups, and access to specialized clinics or medical centers beyond standard treatments.

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What Is Not Covered?

The services below are usually not covered by private health insurance in Germany:

Pre-existing conditions	Private health insurance may exclude coverage for pre-existing conditions, which are health conditions that existed before obtaining the insurance policy.
Cosmetic procedures	Cosmetic surgeries or treatments performed for aesthetic purposes are generally not covered by private health insurance.
Experimental or investigational treatments	Private health insurance may not cover treatments that are still experimental or investigational and not widely accepted or proven effective.
Long-term care	Coverage for long-term care services, such as nursing home care or assistance with activities of daily living, may be limited or require separate insurance.
Certain alternative therapies	Coverage for alternative and complementary therapies may vary, and not all therapies may be fully covered under private health insurance.
Travel-related medical expenses	Private health insurance may not cover medical expenses incurred while traveling outside of Germany. Separate travel insurance is recommended.

How Much Is It?

Unlike statutory health insurance, which is income-based, private health insurance premiums are determined by individual risk factors—here are some possible prices of private health insurance in Germany based on your age.

For younger individuals (under 30 years old)— monthly premiums for private health insurance typically start around €100. Depending on the desired coverage level and individual circumstances, they can go up to €300 or more.
For individuals between 30 and 50— monthly premiums may range from €200 to €500 or more, depending on factors such as health condition, coverage level, and insurance provider.
For individuals over 50 years old— monthly premiums may start around €400 and increase to €800 or more, depending on various factors. Premiums generally increase due to higher health risks associated with age.

For better understanding of how much health insurance will cost you in Germany, use this calculator and popular private insurance companies like Dr. Walter and Feather Insurance are good options.

Germany Health Insurance for Foreign Workers

Foreign workers in Germany must follow the same health-insurance rules as German citizens. If their income exceeds the salary threshold, they may opt out of public health insurance and instead purchase a foreign workers’ private insurance policy. On the other hand, if their income falls below the threshold, they are automatically eligible for public insurance.

Typically, the employer facilitates the registration process by signing up their employees for social contributions. It is worth noting, however, that foreign workers have the option of selecting their own insurance provider. This allows them to choose the health insurance company that best meets their requirements and preferences.

Germany Health Insurance for Students

Germany requires health insurance for international students. Statutory health insurance covers most foreign students’ medical needs. They can use German public health insurance or their home country’s. Statutory health insurance covers doctor visits, hospitalization, prescriptions, and preventive care. The cost is usually affordable as a percentage of their income.

Private student health insurance may be an option for those without statutory insurance or who want more benefits. Foreign students studying in Germany should understand health insurance requirements and find suitable options to ensure they are covered.

Health Insurance for Au Pairs in Germany

Au pairs in Germany are generally not eligible for statutory health insurance. Instead, they are typically required to obtain private health insurance coverage during their stay, which is usually provided by their host family. Au pairs must obtain private health insurance that meets the requirements and covers their entire healthcare needs.

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Dr. Walter and Feather Insurance are two popular insurance providers that cover au pairs in Germany. These companies have a solid reputation for providing dependable insurance solutions, making them popular with au pairs looking for quality healthcare coverage.

Germany Health Insurance for Refugees and Asylum Seekers

Asylum seekers awaiting a decision and recognized refugees usually have access to public health insurance, which covers a wide range of medical services. Refugees and asylum seekers must register with the appropriate authorities and obtain the necessary health insurance coverage to ensure access to the full range of healthcare services they require.

Best Health Insurance Companies in Germany

Here are some of the best insurance companies in Germany:

Public health insurance companies:
AOK (Allgemeine Ortskrankenkasse).
Techniker Krankenkasse (TK).
Barmer.
DAK-Gesundheit.
KKH Kaufmännische Krankenkasse.
BARMER GEK.
IKK Classic.
hkk Krankenkasse.
HEK – Hanseatische Krankenkasse.
KNAPPSCHAFT.

Private health insurance companies:

Allianz Private Krankenversicherung.
AXA Krankenversicherung.
Debeka Krankenversicherung.
DKV Deutsche Krankenversicherung.
Dr. Walter
Continentale Krankenversicherung.
HanseMerkur Krankenversicherung.
HUK-Coburg Krankenversicherung.
Gothaer Krankenversicherung.
LVM Krankenversicherung.

For more

Germany Healthcare System Pros and Cons

While it is world-renowned, Germany’s healthcare has its cons and pros:

Pros	Cons
Universal coverage for all residents.	Long waiting times for non-emergencies.
High quality of care.	Bureaucratic administrative procedures.
Comprehensive benefits coverage.	Regional disparities in access to care.
Patient choice in selecting providers.	Rising healthcare costs.
The option to have private insurance	Limited private insurance eligibility.

What to Do in an Emergency?

If you have a medical emergency in Germany, you should remain calm and call 112 for ambulatory and emergency services, or 110 for the police.

The emergency response system is advanced and capable of dealing with a wide range of medical emergencies. Emergency services in Germany are prepared to provide prompt and effective care in the event of a severe injury, sudden illness, or any other urgent situation.

Does Germany Have Free Healthcare?

Social contributions to Germany’s public healthcare system make it partially free. Patients can receive most medical services for free. GP visits every quarter cost €10, but other low copayments apply.

These small fees help sustain the healthcare system while keeping it affordable for Germans. Thus, while most medical services are free, low copayments may apply to cover healthcare costs.

Can I Have Both Public and Private Health Insurance in Germany?

If certain conditions are met, you can obtain both public and private insurance. Individuals in Germany who exceed the income threshold can continue to be covered by public insurance while purchasing private insurance. Furthermore, self-employed people can enroll in public insurance but must pay the entire healthcare contribution themselves. This allows for dual coverage and the flexibility to obtain additional benefits through private insurance while remaining covered by the public system.

Can I Choose My Doctor in Germany?

Yes, individuals in Germany have the freedom to choose their own doctors and healthcare providers.

How Do I Find a Doctor or Healthcare Provider in Germany?

You can usually search for a public healthcare provider here, for private doctors and hospitals, you may be required to turn to your local directories or immigration office to help you.

Are Mental Health Services Covered by Health Insurance in Germany?

Yes, mental health services are typically covered by health insurance in Germany, including outpatient and inpatient treatments.

Are Pre-Existing Conditions Covered in Germany?

Health insurance companies in Germany are legally required to cover people with pre-existing conditions, though certain waiting periods or exclusions may apply. It is critical to review the policy terms for specific information. You may also notice that private insurance policies do not cover pre-existing conditions or are more expensive.