The German healthcare system

The German healthcare system
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Updated 2021-01-08 13:41

Germany is famous for offering one of the world's best health care. As a matter of fact, insurance in Germany can be divided into two types: state health insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung).

Given that the healthcare quality is very high, waiting times to consult specialists or undergo surgery are rarely lengthy. Patients can choose their own GP and generally do not need any intermediary to consult a specialist. Healthcare costs, however, are rather expensive, and coverage by health care funds is only partial. 

In Germany, health insurance is compulsory and is based on the concept of the welfare state. This means that every person has to pay. The money you have to pay for this type is calculated based on your financial income. The more you earn, the more you will pay for insurance. People who earn less money will have the option to get lower insurance coverage.

 Good to know:

The German health system encourages the prevention of illnesses. For example, complying with annual dentist checkups (and proving this by collecting stamps) may result in lower dental expenses later. Some insurers cover a certain amount of preventative courses such as yoga or fitness classes every year.

The German healthcare system

When starting to work in Germany you will have to choose a health insurance provider and inform your employer. Based on your needs and situation, you will have to choose between the public and private insurance. If your annual gross income is below 60,750 Euros per year, you will need to register with one of the public health funds (Gesetzliche Krankenkasse). You can choose your own public health fund from a wide range of approved providers. The contribution will be deducted from your monthly salary. For certain types of specialised care (eye and dental care), public health funds do not provide optimal protection. You can then take out supplementary private health insurance to get full coverage. If your gross annual income is above 60,750 Euros, if you are self-employed, a freelancer, public officer (Beamter) or a student, you may opt for a private health fund. Generally, all statutory health insurance companies must provide a specified minimum performance. However, individual health insurance companies differ in their additional benefits. These benefits are not mandatory, but may be convenient in specific cases, which can be better organised by a private health fund that allows you to adjust your level of coverage and your monthly contributions based on your own healthcare needs (if you are young, if you do not suffer from chronic diseases, etc.). Therefore, people with a higher income level often opt for private coverage. The public health cover is at a fixed rate, which in most cases works out more expensive for high-level earners. Included services may differ, though the doctors mostly remain the same since you are free to choose your doctor with public insurance.

Usually, the employee and the employer share exactly 50% of the social security contributions, which include:

  • The care insurance (2.55%)
  • Pension insurance (18.7%)
  • Unemployment insurance (3%) 
  • Statutory health insurance with 14.6% (as of 2016).

However, it is often the case that the employee still pays an additional contribution. This can vary between 0.8% and 1.3% and depends on your individual health insurance and your income. Every person earning in Germany has to pay for health insurance. Specific groups also have to contribute like: those who receive unemployment benefit, artists and publicists, disabled people, students, and pensioners. Additionally, there are specific rules for children and registered partnerships.

 Important:

If you opt for private health cover, it may be complicated to change back to the public health system later.

Health insurance in Germany

As a German resident, you are obliged to have health insurance. Otherwise, you will be charged for outstanding contributions. If you have a job, you can choose from the public insurance providers. Insurance plans differ considerably in terms of contributions and voluntary benefits depending on your age or profession, so it is well worth checking around. You can change your public health insurance after 18 months – and a change is quite easy. There are currently 114 Gesetzliche Krankenkassen and most Germans are insured with AOK, DAK, Techniker Krankenkasse or Barmer. Spouses and children can also be insured on your plan.

If you are unemployed, you will have to take on private insurance. In that case, make sure to double-check whether you will be able to access public insurance once you've secured a job. It can be tricky to access public health care after having been insured with a private insurance provider. If you are travelling to Germany as a non-EU member, you need to take out private health insurance before departure. Optimal coverage is essential due to expensive health care costs that might arise from an accident or severe illness. 

There are many insurance companies to choose from in Germany, according to your needs and budget. Some of the leading health insurance providers are:

Consider having a look at their offers according to your needs and get a free quote on Expat.com's Health Insurance for expatriates in Germany page.

European Health Insurance Card

EU citizens are covered in Germany through their European Health Insurance Card (EHIC), which can be helpful during the initial relocation period (if you are still insured in your home country). With the EHIC, health-related costs in the country will be taken in charge in the same conditions as for German nationals. If you don't have an EHIC, visit your national health fund to get some information before leaving for Germany. The card is valid only for state-provided services, and necessary services. However, it is not a substitute for travel insurance. The responsibility for issuing the EHIC does not lie with a person's state of residence, but with the state where a person is paying to or benefiting from the Social Security System, so if you receive your pension and social security in Germany, you would have to register for German healthcare insurance.

 Important:

When moving your habitual residence to Germany, you should register with the S1 form rather than using the EHIC. You can contact your local health insurance authority to locate the relevant institution issuing the S1. Once in possession of the S1, you must submit the form with the local German authority. The EHIC does not cover costs if the purpose of your stay is obtaining medical treatment. 

 Useful links: 

Gesetzliche Krankenkassen - Public health fund
European Health Insurance Card

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