German Health Insurance Simplified (Part I)

by Feather Insurance

New country, new health insurance system. German health insurance can be daunting for new arrivals to the country. In this guide, we aim to simplify the German health insurance system and give you all the information you need to help you figure out which is the best health insurance option for you.

About the Author

Founded in 2018 in Berlin, Feather aims to simplify the world of German insurance, especially for expats. Born out of frustration at the old-school, admin-intensive insurance offerings in Germany, we developed a platform and partnered with the most trusted providers to offer fully digital insurance solutions, in English. Building our brand based on trust and a customer-centric approach, our experts are on call to give honest advice to ensure you get the right coverage to suit your needs when it comes to health, liability, household, or legal insurance.

Why Get Health Insurance?

If you live in Germany, you need to have some form of health insurance. You can't get a residence permit without health insurance. In Germany, you pay for your health insurance with monthly premiums, and your insurance provider pays for your healthcare, either completely or in part, depending on your insurance type.

By law, if you are employed, your employer covers 50% of your health insurance premium for public insurance, or for privately insured employees, they pay 50% up to the maximum they would pay for public insurance. This is a well-streamlined process. In the case of public health insurance, your company will pay for your insurance directly, and deduct your contribution from your salary. For private insurance, you will pay the full premium yourself and your company will reimburse you their share. If you are self-employed, you are responsible for paying the entire premium yourself.

Germany‘s Two Health Insurance Systems:

Public health insurance (gesetzliche Krankenversicherung)

Public health insurance is the most popular option, and the cost is calculated as a percentage of your income. There are many reputable public health insurers, and their cost and coverage are nearly identical.

If you are employed and earn under €66,000/year, you will need to sign up for public health insurance. If you are a student or self-employed, you are also eligible for public health insurance but may choose private insurance instead, if you wish.

Private health insurance (private Krankenversicherung)

With private insurance your monthly cost will depend on factors like your age and health condition when you sign up. Here the coverage can vary a lot from one provider to the next, and so can the costs.

If you are employed and earn over €66,000/year, you can choose between public and private insurances. If you are a student, you can opt for private health, and if you are a student over 30, it may be your only option. If you are self employed you can also opt for private insurance if you are earning a sufficient amount.

Choosing between public and private health insurance can save you a lot of money, and will determine the level of healthcare you receive. We’ve outlined what you need to know about both below, but if you are still unsure, it's best to talk to an expert.

Our friends at Feather insurance can offer you a free consultation in English and will give you their honest, expert advice. Once you have decided, it's extremely simple to sign up to a selection of different insurance providers online with them in just a few minutes. Their site, support and policies are all in English, so they are a great option and help simplify the German insurance landscape for non-German speakers.

Public Health Insurance

Around 90% of German residents have public health insurance (gesetzliche Krankenversicherung). By international standards, the public healthcare system in Germany is very efficient and so this type of coverage works well for many people. In the German public healthcare system, everyone has access to the same treatments and services whether they earn €20,000 or €200,000. The more you earn, the more you pay (up to a maximum amount) — but your benefits will stay exactly the same.

Your monthly premium is calculated as 4.6% of your gross income, plus an average surcharge of 1.1%, with the ceiling for statutory health insurance contributions adjusted annually (€59,850 in 2023).

Pros of Public/Statutory Health Insurance:

  • It is calculated on your income, so lower-income earners will pay less, and if you lose your job your public health insurance is adjusted accordingly.

  • Public health insurance covers your children as well as your spouse if they earn a low income or are unemployed. With private insurance, you will pay for every dependent you want to cover, but on the public insurance scheme known as Familienversicherung, your children are covered until they turn 23 (or 25 if they are studying) and your spouse is covered if they earn less than €485/month. If you have or wish to have children, public health insurance is usually the most cost-effective option in the long term.

  • Public health insurance is simple — if you need to see a doctor or receive treatment, you show your health insurance card at the reception, and your healthcare is taken care of, with zero paperwork or upfront payments required. Should there be any treatment or procedures not included in your public health insurance coverage, your healthcare provider will let you know and let you decide how to proceed.

  • Public health insurance providers cannot turn away applications or charge you more based on your preexisting or arising health issues. This is not the case with Private health providers, who may charge you more or refuse to cover you based on your pre-existing conditions.

  • Public health insurance is usually cheaper and a good option for students under 30 years old, who can expect to pay just €120 per month.

Cons of Public/Statutory Health Insurance

  • On public insurance, you’ll often wait longer for a doctor’s appointment, especially when it comes to specialist doctors. Some practitioners only work with privately insured patients. If you require an English-speaking doctor which already limits your choices, finding one who will see you quickly on public insurance can be tricky.

  • Public health insurance is less comprehensive than private insurance. Although most if not all standard preventative and curative care is covered with public insurance, private insurance goes one step further, offering, for example, more extensive dental care, and prescription eyewear.

  • It's comparatively expensive for young adults — if you are young with a well-paid job and no dependents, private health care can often be a cheaper option for you.

What Is Covered by Public Health Insurance?

Public health insurance covers all necessary healthcare and basic dental care. Important treatments and medical prescriptions are always covered, although there may be a small deductible for some prescriptions.

Dental coverage on public health insurance is fairly limited to basic check-ups, fillings, and x-rays. For this reason, many people opt to sign up for dental insurance to top up their public health insurance. It’s very affordable, and for around just €9/month, signing up for dental insurance will cover you for professional dental cleanings, high-end fillings, crowns, veneers, preventative treatments, and more.

Which Public Health Insurance Provider Should I Choose?

There are many German public health insurance providers to choose from, but you can rest assured that their coverage and costs will be nearly identical due to the strict regulations they need to follow.

Good options for expats include TK and Barmer, or you can visit Feather Insurance and compare the different options on their website in English.

In the Next Article

The second part of this guide will address in more detail the pluses and minuses of private health coverage.

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