The German healthcare system is one of the oldest healthcare systems in the world, dating back to 1880s. The system is organized into two major divisions: Public and Private Health Insurance.

The German public health care system is based on the principle of solidarity. All people insured by a public health insurer receive the same medical care regardless of their financial status. This is achieved through an income-based common fund where everyone contributes to.

German Healthcare System Guide

The German healthcare system is rated as one of the best in the world. It offers a flexible range of choices and extensive coverage. Residents who want to get insurance have many options to choose from and a wide variety of health insurance packages to meet their financial capacities and medical needs. Different health insurance plans vary in terms of coverage, costs and specific conditions.

It’s also important to remember that health insurance in Germany is mandatory by law.  As a foreigner, you won’t be allowed to enter Germany at any cost if you’re not insured. This applies even if you’re a foreign student, a foreign scientist or researcher, a foreign worker, a refugee or an asylum seeker. The intention and the length of your stay won’t make any difference either.

Another important element about the German health care system is that it’s not necessary for you to get a German health insurance plan. Germany has already signed various social security agreements with other countries to enable their citizens to enter Germany while being insured in the country of their origin.

The principle of solidarity

On top of that, the public health care system in Germany is distinguished for its generosity. All people insured by a public health insurer receive the same medical care regardless of their financial status. This is achieved through an income-based common fund mentioned.

Although the German health care system is praised for its unique organization, it’s normal for many expats to have some difficulties to understand it during the very first days they spend in Germany. There are certain requirements to meet and specific rules which change, time to time.

To make it less of a problem here we’re covering the German health care system to the tiniest detail.

Health insurance fees in Germany

The cost of health insurance in Germany has increased significantly in recent years, mainly due to demographic expansion and medical cost inflation. Its total cost is determined based on your income, but it also changes depending on what part of Germany you live at.

By law everyone who earns up to €60,750/year or 5,063/month is obligated to get public health insurance. The law specifies that every person who earns below this fixed value must contribute the same premium charge. Currently all residents registered under a public health insurance providers must share 14.6% of their gross salary for their health insurance plan. In addition, health insurance providers (Krankassen) are allowed to charge their customers with a supplemental rate of 0.9%.

For instance, if you earn €5,000 each month then it means €730 must be allocated towards your insurance fund. This amount is paid equally by you and your employer. In other words this means the higher you earn the higher you pay. If your income exceeds the limit mentioned above, you’re not charged with higher fees.

If you earn more than €60,750 you can decide to get private health insurance in Germany. Some other categories of people like civil servants, part-time employees and self-employed people can also get this type of insurance. The cost you pay for your private health insurance plan depends on what coverage and extra benefits you want to receive. You have plenty of choices in terms of different private insurance plans offered and you can customize your plan to fit your personal medical needs.

People in Germany are also required by law to get nursing care insurance (Pflegepflichtversicherung). The cost for this type of insurance was slightly increased by 0.5% as of January 2018. In the present, 3.05 or (3.3% of your gross salary if you have no children) will be paid for nursing care insurance.

Public Health Insurance Premiums for 2019

As of 2019 residents in Germany covered under the statutory health care scheme have to share 14.6% of their gross salary for the common public health insurance fund. Given that, it means the cost of public insurance depends on one’s earnings.

In order to have a better general idea about how much public health insurance can cost let’s have a look at a person whose monthly earnings are around the national average wage.

The table below shows insurance and supplemental rates a resident who earns €3,900 each month is charged by some public health insurance companies in Germany.

German Healthcare Statistics

  • Based on official statistics, more than 70 million residents or around 90% of the entire population in Germany are entitled to statutory health insurance.
  • Currently, 110 accredited health insurance providers (Krankenkassen) operate in Germany. There were more of them but some faced bankruptcy and some others merged together.
  • Germany has the highest health expenditure per capita (4,019 euro). Latest statistics show that as of 2017 health expenditure in Germany is 376 billion euros, 4.7% more than in the previous year. This means health expenditure in Germany per each day exceeds a billion.
  • Germany spends more than 11% of its GDP on the national health care system. The EU average is around 9.6%.
  • There are around 2,000 hospitals operating in Germany. There used to be more but many of them merged into a single entity to increase their capacities and further improve the quality of their medical service.

Healthcare in Germany Glossary

Another element that differentiates the German health care system is its unique vocabulary.

Here is a short list of words you will probably encounter related to the German healthcare system:

  • Krankenversicherung – Health insurance.
  • Lebensversicherung – Life insurance.
  • Gesetzliche Lrankenversicherung (GKV) – Mandatory health insurance.
  • Private Kranken Versicherung (PKV) – Private health insurance.
  • Krankenkasse – Health insurance provider.
  • Krankenhäus – Hospital.
  • Ärzte – Doctors.
  • Notaufnahme – Emergency room.
  • Pflegepflichtversicherung – Mandatory state nursing care insurance.
  • Angehörige – Dependents.
Health Insurance Provider Contribution Rate 2019 Supplemental Rate 2019
  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

 

Health Insurance in Germany For International Students

So far Germany ranks among the most popular study destinations in the world hosting over than 378,000 international students. At any point during their application process, these students have gone through, they have had to provide proper evidence that they have health insurance enough to cover themselves while in Germany. Likewise, if you’re looking forward to being one of those students, then you must keep in mind that proper health insurance is of critical importance for your admission at a university and for getting your student visa.

As a foreign student, it’s upon your choice to choose whether you want to get public or private health insurance. The majority of students pick the former mainly because it is cheaper. On the other hand, private health insurance is more expensive, but there are more benefits included.

Requirements to get a student health insurance plan in Germany change depending on your nationality and the provider (Krankenkassen) you choose. If you’re an EU student it is likely that the insurance in your home country will be recognized in Germany.

In addition, if you’re a student from a country with whom Germany has already signed a social security agreement, your health insurance plan you have taken in your home country can cover you. However, be aware that certain exclusive criteria may apply. Others that don’t find themselves on any of the above categories are required to get German health insurance.

Health Insurance In Germany For Foreign Guest Scientists And Researchers

German universities attract a large number of foreign academics and researchers who go to Germany to hold speeches or attend important science conferences. Whatever the purpose or the importance of their visit, the insurance law is clear and makes no exemption. Every foreign guest scientist and researcher is planning to enter Germany must prove to be health insured well on time.

Health Insurance In Germany For Foreign Workers

Germany is one of the strongest economies in the world and a large number of qualified expats go there to work. Current legal base concerning health insurance obligates ever foreign citizens engaged in a work contract to get health insurance to do his job. It is very important for you to remember that the laws in power state that your health insurance plan is paid equally by you and your employer.

Health Insurance in Germany For Refugees and Asylum Seekers

In recent years, Germany has also been a frequent final destination for a huge flow of refugees and asylum seekers. Similar to other residents, it is mandatory for refugees and asylum seekers to be insured. If you’re residing in Germany as a refugee or an asylum seeker one important thing to be aware of is that your insurance coverage is quite limited. Common medical services you will be offered include basic medical check-ups, treatment for acute illness, and nursing care for pregnant women. However, the range of medical assistance can be extended if the patient needs urgent treatment.

Getting Urgent Medical Care in Germany

Medical health care system is so flexible that it allows individual cases to be treated separately.  In a situation of emergency call an ambulance in the European number 112. If you can reach hospital other than by an ambulance make sure to find an available emergency room at the hospital. Remember that an emergency room in Germany is called Notaufnahme. You’re going to get the required medical care even if you don’t have proper health insurance. In such occasion, you will have to pay for medical costs. If you don’t have money to do it at the moment doctors will still deliver and you will receive a bill for the cost of your stay and treatment.

The Benefits of Private and Public Healthcare (Comparison)

As much as financial matters must be given an utmost priority, one must always take into consideration the benefits a certain type of health care or insurance package has to offer. It is quite reasonable that nobody is willing to empty his/her pockets for an insurance plan that is far to meet medical needs.  That in mind, before deciding which type of health insurance to get a person must dig deeper for benefits each one has to offer.

Listed below are some benefits public and private health insurance in Germany offers

The Benefits of Public Health Insurance in Germany:

Recognized Across The EU

For people who are always on the move German public health insurance is a perfect deal. In general, it offers wider coverage than most public insurance scheme elsewhere. Germany is part of the common European healthcare scheme known as EHIC. This is an assurance that everyone undertaking public health insurance in Germany will have his/her medical needs covered in each EU country which is a member of this large healthcare framework. At the same time, Germany has already signed social security agreements with several other countries where German public health insurance is deemed sufficient.

Much Affordable Costs

The cost of public health insurance in Germany is, unfortunately, increasing slowly from year to year. However, taken overall its costs is much affordable from what people in other countries are typically charged.

Coverage for Non-Working Dependents

Typically a private health insurance plan covers a single person. That in mind, the cost for a family who would be taking private health insurance would be hard to afford. Fortunately, public health insurance in Germany provides coverage for any non-working dependents. Under the mandatory health insurance scheme, a resident is obligated to register his/her non-working dependent to the insurance provider of his/her choice so they can receive the same medical assistance free of charge when needed.

Sick Pay Insurance

German public health care system is especially valued for its unique sense of solidarity toward common welfare. Fundamentally the main principle is those who earn more contribute more and all benefit the same. When a person gets ill his/her employer is legally required to pay him/her a specific proportion of his/her salary to be able to cover mandatory health insurance costs.

This only lasts for a certain time after which the German employer has no obligations toward his employees. Under current rules, an employee who is unable to work will be paid fully for up to six weeks. For the next three years after that, the employer will pay 70% of his/her salary. In other words, current statutory sick pay in Germany is up to €3,045 or around €2,700 after taxes are subtracted. Sick pay insurance might be offered under private health insurance scheme, but benefits are certainly much limited.

Nominal Fees at Hospitals

Those who have public health insurance in Germany are equipped with a membership card. Every time medical treatment is being delivered patients only have to show their card and pay a nominal fee of a few euros and their insurance provider will take care of the rest.

Co-Payment

There are several other medical services to which German public healthcare insurance does not offer coverage. But for many additional medical needs patients in Germany are oftentimes required to only pay a reduced amount of money while the rest will be covered by their public insurance plan (Zusatzzahlungen).

Benefits Public Health Insurance Private Health Insurance
Recognized Across the EU YES. Partially.
Affordable Costs YES. HIGH.
Coverage For Non-Working Dependents YES. NO.
Sick Pay Insurance YES. YES, but highly limited.
Nominal Fees YES. NO, all money has to be paid upfront.
Co-Payment YES. NO.

For certain people who meet certain financial requirements, private health insurance can turn a lot more beneficial. Among others, it can be for the following reasons

Extensive Coverage

Private insurance in Germany comes at a much higher price, but at the same time provides a lot more benefits that its public counterpart. People insured under a private insurance plan enjoy in and out-patient hospital care, comprehensive dental care, surgical interventions etc.

Private Doctors

Residents in Germany insured through a private company can seek treatment from private doctors who are otherwise not available to all patients and all the time.

Flexible Medical Service

Medical services offered to private patients is very fast and efficient. Surely because their financial contributions are higher they often cut queues in hospital halls. Moreover, private patients who need a surgical intervention can ask for a particular doctor to do the medical operation.

Extensive Dental Care

The cost of dental care in Germany is high as in most countries. Usually, private health insurance plans include extensive coverage apart from regular dental check-ups offered under statutory health insurance in Germany.

English-speaking doctors

For an expat who has no prior knowledge in the German language getting private health insurance, it means he/she won’t deal with language barriers because most private doctors do communicate in English or any other foreign language as well.

Benefits Private Health Care System Public Health Care System
Extensive Coverage YES. NO.
Private Doctors YES. NO.
Flexible Medical Services High Flexibility. Very little flexibility.
Extensive Dental Care YES. NO.
English-speaking Doctors YES. NO.

German Health Care System Pros and Cons

German health care system enjoys a reputation as one of the best in the world. From the perspective of a native American, the German health care system is actually a perfect one. It offers a wide range of choices, extensive coverage and professional medical treatment.

But like everything else the German health care system has some drawbacks as well. These might not be major issues but knowing two sides of the same medal is always worth knowing.

Here are some major pros and cons of the German health care system:

Pros:

Extensive Coverage

In the US people spend hundreds of dollars each month for their health insurance but the extension of the medical assistance they receive when they really need is very limited. In Germany the cost of health insurance is relatively high, however, is a perfect value for money taking into account its coverage and benefits it offers. Moreover, doctors and other medical personnel are always required to provide their patients with qualitative, supportive and caring medical service.

Flexible Private Insurance Plans

Public health care system in Germany is designed to only cover some basic medical needs. If one person suffers from an acute illness or has financial capacities to have himself/herself covered to a larger extent, then private insurance is an opportunity. The private insurance scheme is characterized as very flexible in that it offers a wide range of choices in terms of coverage and costs. Health insurance plans are offered to meet different medical needs caused by specific illnesses or medical circumstances.

Choosing Personal Private Surgeon

People in Germany insured through a private health insurance scheme are treated as private patients. As such, the range and the intensity of medical assistance they receive are wide and extensive compared to a person undertaking statutory health insurance. Among the advantages that come along with being privately insured in Germany is that private patients have the opportunity to choose a doctor to deliver their surgery. Moreover, private patients have the freedom to often cut waiting queues.

Switch Insurance Provider

Health insurance companies operating in Germany are obligated to offer coverage for a list of basic medical needs at the very least. But, at the same time, the current legal basis provides some space for a certain degree of independence when it comes to premiums people are charged and coverage they benefit. In many countries, people often get stuck in a particular health insurance provider whose insurance plans come at a high price. Worse still they’re not allowed to seek a better option for a long time.

People in Germany are free to decide to switch insurance provider if a cheaper and better alternative comes along. At the minimum the membership at a chosen insurance provider is obligatory for 18 months and after that people are free to decide whether to stay or leave.

Cons:

Language Barrier

Language is a common problem foreigners seeking medical treatment in Germany face. An expat insured through a public scheme will hardly find a registered doctor who communicates in English or any other foreign language. In difference, the number of private doctors who speak a foreign language is higher.

Partial Coverage For Some Medications

The list of medications for which statutory health insurance in Germany provides coverage is actually limited. There are some of them that patients must pay out of their pocket either the total cost or a portion of it. This is not a major issue to many but surely is worth knowing.

Salaries For Medical Practitioners Are Not High Enough

Germany has one of the highest numbers of registered doctors per resident. However, doctors in Germany earn less than they would earn elsewhere. Due to this many doctors in Germany flee their country and go to places where their income goes higher. To a large extent the German medical health care system has strongly relied on recruiting foreign qualified doctors but it seems difficult to keep pace with ever-growing medical needs of their population.

Health Insurance Costs in Germany Are Increasing

Demographic expansion and medical cost inflation in recent years have led insurance companies in a difficult situation where they had to charge higher premiums to be able to cover the ever-growing medical needs of their clients. As of 2019, the government in Germany has given permission to public health insurance providers to charge a supplemental rate of 1% at maximum to their clients. At the same time, they’re working to avoid a further increase in the cost of health insurance in Germany by making hospitals more competitive.

Private Patients Must Pay Upfront

People in Germany who are insured through a recognized public health insurance provider have to show their insurance card and pay a nominal fee at the hospital. In contrast to that those who are undertaking a private health insurance plan are required to pay in cash at the time treatment is being delivered and after that, they can seek reimbursement from their insurance provider. This often a major disadvantage especially when an expensive medical treatment is needed. 

Additional benefits of the German health insurance system

Health insurance is mandatory by law

A medical reform that came into power in 2009 obligated everyone residing in Germany for whatever reason or whatever intended period of time to have proper medical coverage. This is actually a major advantage because otherwise many would decide to remain uninsured thinking that this way they would save a lot of money. The truth is however that one will always need regular medical check-ups and other medical assistance. In situations like that proper health insurance is always beneficial.

Solidarity Principle

In many other countries, the model of the healthcare system is organized in that way it offers a great advantage to the rich. The German health system, on the other hand, is entirely built on the principle of solidarity. Everyone who is entitled to the German public health insurance scheme shares the same percentage from their gross salary to the common public insurance fund. In turn, everyone is giving the same coverage and the same quality of medical services. Moreover, when an individual is working his/her employer is legally required to contribute half of the amount the person has to pay for health insurance.

Combine Private and Health Insurance in Germany

An element that it really emphasized the flexibility of the whole German health care system is that it allows people to get a combination of both. This is done on the purpose of allowing them to suit health insurance coverage to their personal medical needs and financial capacities as well.

Foreign Public Health Insurance Recognized in Germany

A major advantage that makes the German health care system unique is that it runs several social security agreements of bilateral recognition of public health insurance. Germany is a major attraction for many expats and such advantage helps them skip some steps and embark on their trip to Germany right away. Currently, foreign citizens who carry out public health insurance in the EU and EEA countries can freely enter Germany without having to get German statutory health insurance.

In addition, citizens of the following countries who are entitled to their native public health insurance scheme are exempted from German public health insurance

Bosnia and Herzegovina, Iceland, Israel, Liechtenstein, Morocco, Macedonia, Montenegro, Serbia, Tunisia and Turkey.