Germany has a reputation for having one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. Approximately 85% of the population is mandatory or voluntary members of the public health scheme while the rest have private health insurance.
The health insurance reform of 2007 now requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment. This must also include coverage for pregnancy and certain medical check-ups.
As people have different requirements or expectations from health insurance, it is important to understand the system in order to filter out the most suitable plan while living in Germany.
Health insurance is not a commodity but rather is a vital financial support in times of illness or after an accident.
Some health insurance policies offer less coverage than others and the scope and quality of terms and conditions are of utmost importance.
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Public insurance
Regular salaried employees must have public health insurance, unless their income exceeds 60,750€ per year (2019). If their income exceeds that amount, they can have private health insurance instead. Freelancers can have public or private insurance, regardless of their income.
In the Public system the premium
- is set by the Federal Ministry of Health based on a fixed set of covered services as described in the German Social Law (Sozialgesetzbuch – SGB), which limits those services to “economically viable, sufficient, necessary and meaningful services”
- is not dependent on an individual’s health condition, but a percentage (currently 15.5%, 7.3% of which is covered by the employer) of salaried income under €54,450 per year (in 2019).
- includes family members of any family members, or “registered member” ( Familienversicherung – i.e., husband/wife and children are free)
- is a “pay as you go” system – there is no saving for an individual’s higher health costs with rising age or existing conditions.
The medical benefits offered include in-patient (hospital) care as a ward patient with the doctor on duty at your nearest hospital, out-patient care with registered doctors (Kassenarzte) and basic dental care. Please note that there is no coverage for private doctors or surgeons, a private room in hospital, alternative/homeopathic medical care, dental subsidies beyond the very basics, and vision products for adults or any medical benefits outside of Europe. Your nonworking dependents living at your address in Germany are presently insured at no additional cost and simply need to be registered with the same Krankenkasse as yourself as the paying member.
Private insurance
In the Private system the premium
- is based on an individual agreement between the insurance company and the insured person defining the set of covered services and the percentage of coverage
- depends on the amount of services chosen and the person’s risk and age of entry into the private system
- is used to build up savings for the rising health costs at higher age (required by law)
For persons who have opted out of the public health insurance system to get private health insurance, it can prove difficult to subsequently go back to the public system, since this is only possible under certain circumstances, for example, if they are not yet 55 years of age and their income drops below the level required for private selection. Since private health insurance is usually more expensive than public health insurance, the higher premiums must then be paid out of a lower income. During the last twenty years[when?] private health insurance became more and more expensive and less efficient compared with public insurance.
In Germany, all privately financed products and services for health are assigned as part of the ‘second health market’. Unlike the ‘first health market,’ they are usually not paid by public or private health insurance. Patients with public health insurance paid privately about 1.5 Billion Euro in this market segment in 2011, while already 82% of physicians offered their patients in their practices individual services were not covered by the patient’s insurances; the benefits of these services are controversially discussed. Private investments in fitness, for wellness, assisted the living, and health tourism is not included in this amount. The ‘second health market’ in Germany is compared to the United States still relatively small but is growing continuously.
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Self-payment (International patients without any national insurance coverage)
Besides the primary governmental health insurance and the secondary private health insurance mentioned above, all governmental and private clinics generally work in an inpatient setting with a prepayment-system, requiring a cost-estimate that needs to be covered before the perspective therapy can be planned. Several university hospitals in Germany have therefore country-specific quotes for pre-payments that can differ from 100% to the estimated costs and the likelihood of unexpected additional costs, i.e. due to risks for medical complications.
Who can get which Health insurance policy?
Public Health Insurance:
- Everyone
Private Health Insurance:
- Self-employed / freelancers or
- Students (must
setup withinfirst 3 months after enrolment) or - employees with a gross salary above 59400 EUR per year
So as everyone can get public ones, only some of you can get a private option.
How do they work in practice?
Using a Public Health Insurance
With a public health insurance, you get a chip card and can go to doctors who accept publicly insured patients. Nearly all of them do, however some might give earlier appointments and better treatment to privately insured.
Good things is: There is nearly no paperwork to do for you. You simply go, show the card and if they accept it they will treat you and will deal with your health insurance on their own.
Using a Private Health Insurance
This is different with private insurances: There, after the treatment, you will receive an invoice from the doctor which you then need to send to your insurance. They will then pay the costs to you, so you can pay your doctor.
Problem: If there’s any issue with the invoice, and your private insurance does not want to cover it then you have to deal with it: Ask the doctor what went wrong, go back to the insurance and so on.
On the plus side: Private insurances often cover more things than public ones, and doctor’s are often happier to accept you – since they can bill higher rates.
How much do they cost?
Costs of a public health insurance option
For Students
Students are the easiest: A fixed fee of around 70 EUR per month needs to go to them. That is by far the cheapest and simplest option you can get. (However, you need to be under 30.)
For Freelancers
For freelancers, they calculate your rates by your income: Roughly 16% of what you make goes to them.
However, they have a minimum assessment base (Mindestbeitragsbemessungsgrundlage). It means that they assume you make at least 1038 EUR per month – no matter how much you actually make. So you will pay at least around 171 EUR per month.
For Employees
Your rate is calculated by your (actual) income, it will be all done by the bookkeepers of your boss, so nothing to worry or deal about.
Costs of a Private Health Insurance
Private Insurances don’t care about your income, they practically only go by your age, gender and health status / history. So their rates can be very different, depending totally on you.
They often also offer a deductible (Selbstbehalt): For instance, with a deductible of 1000 EUR per year, you will pay the first doctor’s invoices up to 1000 EUR from your own pocket, only the ones above will be covered by your insurance.
Why would you want a deductible? Usually, it makes your monthly rates much lower. So if you rarely go to the doctor and just want to be covered in cases where you get hit by a truck or similar, a deductible might be a good option.
Roughly speaking: If you’re a freelancer, healthy, very young and male, then a private health insurance (with a high deductible) starts at 120 EUR monthly.
