Health Insurance Germany:
All You Need to Know
Health insurance is taken extremely seriously in Germany, a country which has a strong claim to being the originator of the system. Personal health insurance has been an essential requirement for every person permanently residing in Germany since 2009 and it is also necessary for short-term stays in the country - without it, a visa will not be issued. The German healthcare system is one of the most impressive in the world with virtually non-existent waiting lists and cutting-edge treatments, but health insurance Germany is undeniably complex.
Read on to find out how it works and how to navigate the system as an expat.
Germany is rightly famous for its comprehensive and universal health care system, the nature of which means that all residents of the country need to have valid Krankenversicherung or health insurance. If you are planning to live in Germany as an expat, you will need to choose between private healthcare cover (PHI) or state German health insurance (SHI). Restrictions do apply, however to eligibility for each. The vast majority of Germans opt for state health insurance topped up with private insurance. The remaining 10 percent choose full private cover.
Monthly premiums are expensive, but if you need medical treatment, the amount you will be charged will be low. The legislation is in place to ensure that all health insurance policies provide cover for a wide range of medical conditions and treatments.
Explaining the German Health Care System in 3 mmin. (Video)
Statutory health insurance (GKV/SHI)
and the solidarity principle
Most Germans are members of the Government Health Insurance System. If you earn less than 59400 euros (gross) membership is mandatory. Monthly premiums cost approximately 377 euros to which is added an employer contribution of approximately 325 euros.
The minimum membership term is 18 months after which you can transfer to a private policy if you wish. If you're self-employed, you'll have to make up the difference unless you work in an eligible artistic provision, in which case you can apply for the state to make a contribution - more about this below.
Generally, you will be able to apply for German health insurance if one of the following applies to you:
There is a cap on the amount of the monthly premium, the maximum amount that can be charged is 683 euros per month. However, all non-working dependants in your household will also be covered with your policy as long as they are registered as living at the same address. The medical benefits of the GKV include in-patient care at your nearest hospital, basic dental care and out-patient care with a doctor. It is important to note that private medical care is not covered and dental treatment only covers the most basic. The GKV is supported by the state but administered by a number of independent non-profit organisations.
Private Health Insurance Germany
There is a wide range of private healthcare insurance plans in Germany. Private medical insurance means that you can access private healthcare and can expect a more in-depth service from the medical profession. If you are an expat, private health insurance is highly recommended if you don't speak German very well as you can request a doctor who speaks your native language.
There are about 40 health insurance providers in Germany offering policies to suit all budgets. The cost of the premiums is based on the level of cover, combined with your entry age and whether you have any existing medical conditions. The latter is one of the major differences between PKV and GKV - as PKV is run by private companies, they calculate their premiums based on the amount of risk you pose to them. Unlike the GKV, each member of a household will need to have their own policy so it is more expensive for a family. You can apply for private health insurance Germany if you earn more approximately 58,000 euros per annum; (PKV often works out cheaper for self-employed Germans or if you are a student).
If you are coming to Germany hoping to work on a freelance basis, health insurance is probably one of your main concerns. For freelancers and the self-employed, there are several options. The simplest is getting an international expat health insurance policy either online or from your home country. These policies usually offer basic cover - they will probably not cover checkups, dental work or alternative therapies, such as acupuncture. However, they can be an affordable solution, with premiums starting from 75 euros per month.
The other option is to apply for the KSK. It’s not an insurance provider as such, rather a state institution which pays fifty percent of the contributions to health, pension and old-age care insurance for insured artists. Completing the application is time-consuming and difficult - many find it worthwhile using the services of a special consultant. However, once you've been accepted, the KSK is a fantastic deal, and very cheap in comparison with every other health insurance solution for freelancers in artistic professions.
If you are a young freelancer starting out but are confident about dealing with German bureaucrats, you would be well-advised to head to the Job Centre and apply for a subsidy to cover the costs of your insurance in the initial phase of yourself-employments. Unsurprisingly, you can expect to have to complete a lot of paperwork and convince officials that you will soon be earning enough money to pay for your own healthcare. If you meet the criteria, however, your health insurance worries will be over, at least until you find your feet.
Health Insurance Germany Expat
EU and EEA (European Economic Area) citizens, and citizens of Iceland, Norway and Switzerland, are entitled to access healthcare in Germany as long as they have registered for an EHIC card and are travelling in the country on a temporary basis that does not exceed one year. Citizens from other countries may also be entitled to receive German healthcare whilst in the country if there is a reciprocal agreement between the two countries in place. Otherwise, they will have to pay for healthcare. It is worth seeking advice from your local government or consulate official to clarify the situation.
If you are an expat who has moved to Germany to work and live, you will need to register with a private healthcare insurance provider for some time before you will be able to access the state healthcare system. This can be tricky as many private companies are reluctant to offer insurance policies to foreigners.
Initially applying for healthcare insurance can be problematic for expats as many private healthcare insurance providers insist on a residence permit. In a 'Catch 22' situation, however, it is necessary to have valid healthcare insurance to be granted a work or residence permit. Consulting the advice of a specialist insurance broker regarding health insurance Germany expat is highly recommended.
If you are employed by a large company, your employer will probably register you with a German company, although you are free to select your own provider. Although there are specific expat health insurance providers, it is probably most sensible to use a German company as there have been issues with German medical authorities refusing to recognise the medical certificated provided by foreign providers. This has caused serious and highly stressful situations for many expats through no fault of their own.
If you are an expat suffering from serious pre-existing health conditions, it is worth applying for the 'Basistarif'. This obliges private insurers to accept you under the same terms a the state health insurance system.
(Compulsory Nursing Care Insurance)
Nursing care insurance is compulsory for Germans and expats and is used to pay for nursing costs such as bathing and feeding. There are different levels of nursing assistance. Nursing insurance was recently overhauled in 2017 and now just over 2 percent of your monthly salary is used to pay for any care you might need in old age or indeed at any point in your life. It is normally automatically taken out alongside a healthcare policy with the same company (as long as it is a German one) and it is a legal requirement.
Sick Pay Insurance
If you were to become ill and unable to work, your employer will typically pay six weeks' full salary. The government scheme health insurer (Krankenkasse) will then kick in and pay a percentage of your income for up to 78 weeks. The amount of statutory sick pay (Krankengeld) you can receive is approximately 3,090 Euros per month. To give a clearer picture, after taxes have been deducted, you would be left with roughly 2,725 euros to cover your normal monthly living expenses such as rent, groceries and bills.
Higher earners might wish to explore the possibility of purchasing supplemental sick pay insurance, which is available at affordable rates. This is especially significant if your monthly living expenses exceed 2,724 Euros. If you plan to purchase private medical insurance, purchasing sick pay insurance at the same time is sensible. However, it is important to note that these policies do not cover permanent disability and they are only paid with the expectation that the claimant will quickly return to full employment. This means that you might wish to take out another policy covering long-term disability and critical illness.
Cross-Border Care, Travel Insurance and Evacuation Benefits
EU cross-border regulations came into effect in 2013 meaning that residents of the EU and EEA can opt to have their medical treatment in any member state. It is important to note, however, that many foreign doctors will only accept private health insurance cover. Medical evacuation or repatriation from other countries is not covered by the GKV.
People coming to Germany are officially required to show proof of health or travel insurance in the country before they are granted with a visa. Many expats are able to purchase Schengen travel insurance which covers anywhere within the Schengen zone. This is an affordable and straightforward process. Many reputable companies offer online registration with monthly premiums of 20 euros or less per month.
If you are a German citizen, your healthcare insurance may not cover you in non-EU countries or offer the same cover as a typical travel insurance policy, such as holiday curtailment, flight or hotel cancellations and lost luggage. If planning to travel within the EU, you will need to apply for a European Health Insurance Card (EHIC) which permits travellers to access the same level of healthcare as local residents of any country within the EU.
There are two options for travel insurance in Germany. You can either take out a short-term travel insurance policy or an annual travel insurance policy (Reiseversicherung) which offers full coverage for an entire year and is a good option if you travel frequently. There are usually no restrictions on how often you can travel but it might be a good idea to check the maximum duration of each trip, which ranges from around 30–45 days depending on the policy and the company.
Reassuringly for expats, Germany is the home to some of the world's best dentistry. If you have healthcare insurance, you will be covered for routine dental procedures, such as check-ups, fillings and dental hygiene. Anything more complex, however, is only partially covered by state healthcare policies. If you suspect you may need major dental work, you will be far better off with private insurance coverage that includes dental care.
When looking at policies, check the terms and conditions carefully. Many have an eight-month waiting period before you can make a claim. If you have state health insurance, find out what is and isn't covered. With the current government cutback reducing the number of payments to dentists, it might be a good idea to take out supplementary private cover.
When visiting a German pharmacy (Apotheke) you will only be able to buy prescription medication if your prescription has been signed by a German doctor. However, a German doctor might be willing to sign your foreign prescription without a further examination if you bring it with you to an appointment.
Most medications require a co-payment of between 5 to 10 euros so make sure you take some cash with you when going to a German pharmacy. Some private health insurance policies cover the co-payment, as well as the cost of the medication but you will need to pay for the whole cost of the medication in advance. Make sure you keep the receipt so that you can be reimbursed by your insurance company at a later date.
Many medications are sold under different brand names in Germany so always ask for the active ingredients. Pharmacists are highly qualified and knowledgeable and will be able to offer advice.
Do I need to choose a family doctor/GP?
Yes, you will need to find a GP in case you need to be signed off work, access prescription medication or to be referred to a specialist for hospital treatment. Make sure you bring your health insurance card each time you see a doctor. It's easy to find a GP as all are listed online or in your local phone directory. Contact your local embassy to find out information about doctors who are able to speak English.
Are pre-existing conditions covered?
Pre-existing conditions are covered by the state health insurance. If you opt for private insurance, your premiums will probably be higher if you have pre-existing medical conditions.
Are there any deductions I can make for medical expenses in my German taxes?
Since 2010, a not insignificant proportion of health insurance costs has been tax deductible from the income of expats. However, this is only possible if your medical expenses exceed a certain percentage of your gross income - there is a complex formula determining the 'reasonable load'.
How do I sign up for medical insurance?
Do your research and complete the online application form of your chosen company.
What happens if I am unemployed?
If you lose your job, you will be entitled to access the public health insurance system if you are from one of the following countries (Latvia, Estonia, Lithuania, Poland, Slovakia, Slovenia, Czeque Republic and Hungary) and can prove that you were a member of the statutory state health insurance system in your home country. If you are from another country, you will need to try and get private health insurance.
Which insurance company should I choose?
If you are eligible to join the state system, you can choose between 113 Krankenkassen. Opt for one which offers English-speaking staff to make your life easier, such as TK, which has a very good reputation among the expat community in Germany.
If you decide on private healthcare cover, the main companies are DKV, Allianz, and AXA, which offers expat-tailored health insurance packages.