Health Insurance in Germany

If you are an English-speaking expat, it is crucial for you to understand the system of Health Insurance in Germany. There are various types of health insurance plans available and choosing one that best suits your needs can be challenging.

This blog will make sure that you have all the essential information to make informed decisions about your healthcare coverage in Germany. We’ll provide a comprehensive guide regarding health insurance in Germany so that every expat can navigate this often confusing area without incurring any significant financial cost. From decoding the different options available in regards to the country’s healthcare system to providing details on different types of insurance plans, we aim to cover everything for you!

A guide through one of the best health care systems in the world.

One of the most important steps when coming to Germany as an expat is to take out health insurance.

However, the German health insurance system can be a bit confusing. There is statutory health insurance (Gesetzliche Krankenversicherung), there is private health insurance and there is supplementary insurance. But which of these do I need? What is right and important for me?

We explain.

State Health Insurance („Gesetzliche Krankenversicherung“)

One thing first: Health Care Insurance is mandatory in Germany, however you do have options.

You are required to have state health insurance unless your annual income before tax is over €64,350, you earn less than €450 per month, or you are self-employed. In these cases you can choose to insure yourself privately instead.

Your employer will pay half of your health insurance costs, including the supplementary charge. However, the maximum amount they will contribute is €384.58/month for your health care and €73.77/month for your nursing care insurance. If the premiums are higher, you will be responsible for covering the costs on your own.

The Gesetzliche Krankenversicherung (‘GKV’)  is a family insurance plan, which means that your spouse and children are automatically insured under your plan at no extra cost.

There are, however, hidden costs in the ‘GKV.’ An excess of €10 will be charged for each day spent in hospital (max. €280) and up to €10 per prescription (only generics). Glasses are not covered (apart from extreme medical cases) and dental health is only partly covered. It is possible to supplement your health insurance through supplementary private insurance cover.

Despite any prior medical history, the ‘GKV’ is mandated to provide coverage for you.

Health Care in Germany is of a very high standard, regardless of which system suits your personal situation best. To meet the standards of German authorities, health care must include all medically necessary treatments; reimbursement restrictions are not allowed.

Private Health Care

In addition to the state health insurance, there is also the possibility of a private health insurance. This offers many advantages, but usually also has its price. There is no family membership available in German private health care insurance, meaning everybody has to pay premiums.

The premiums for private health care are based on age, specification of the health care cover and health. If you are single and earn a good income, you can usually get much better health care coverage than the state health care plan for lower monthly premiums. If you have a partner who does not work or several children, private health care is usually less cost-effective than state schemes.

If someone joins a private health scheme, it is hard for them to go back to the state health scheme later if they want to.When a person is covered by private insurance after the age of 55, there are only limited avenues to move to the state system.

The PKV

The Private Krankenversicherung (PKV) does not have to supply insurance coverage if you do not fit the qualifications for health that are needed. Without prior residence in Germany, certain private insurance companies will not extend coverage to individuals coming from abroad.

Customizing your health care coverage is possible with the many tariffs available. This allows you to create a plan that is precisely tailored to your requirements. Patients have the freedom to choose their doctor and hospital, with options for single or double rooms. Additionally, alternative health care, dental care, and opticians services are included in the coverage.

Depending on the tariff you select, a yearly additional payment or payments for particular benefits like dental care or alternative medical treatment might be required.

Waiting times for private healthcare patients are usually much shorter than those insured by the state system, due to doctors getting higher payments from them.

Generally with most tariffs the level of cover is higher than in the state health care schemes. This results that in certain medical situations there are different treatments, precautionary check-ups and medications available. In contrast to the state health care system, with this type of care there are no additional costs that must be paid solely by the patient.

Supplementary Health Insurance & Dental Insurance Germany

If you choose to be state health insured or if you do not meet the criteria to insure yourself or your family privately, you can upgrade your state health insurance through a range of supplementary insurances. The supplementary insurances are designed to fill the gaps, both in treatment and financially, within state health care, making it possible for you to design the cover that suits your needs and wishes. It is possible to achieve almost the same coverage that a private health insurance offers. There is no obligation for you to be granted supplementary cover, and insurance companies will make you answer questions about your state of health.

Gaps in the State Health Care System

Alternative medicine and natural remedies are not a part of the state health system and therefore have to be paid privately. Alternative medicine includes treatment through homeopathy, traditional Chinese medicine and osteopathy.

The costs of dental treatment and prostheses are only partly covered by the state system. The rule is that dental prostheses will be paid for at roughly 50% of the most economic but functional treatment. Should you wish for a higher standard of treatment the costs you have to pay are even higher. For a dental implant, which can cost up to €4000 you have to cover around 80% of the cost.

Visual aids such as glasses and contact lenses are not paid for unless you have a serious eye disorder.

Prescribed medications are solely generics and for these you also have to pay between €5 and €10 per prescription (children excluded).

Check-ups and screenings are limited in form and frequency. Should you wish for better or more frequent care you have to pay for it privately.

There is a system of co-payments in place for items such as prescriptions, external remedies (such as massages), and €10 per day for hospital stays (up to 28 days per year).

In hospital, the state inpatient care consists of multi-bed rooms and the doctor on duty. There are high costs that you will need to cover if you want a single or double room, or to be seen by a senior physician.

The system in place for medical aids (hearing aids, wheel chairs, orthopaedic shoes and stockings, etc.) is similar to the dental system. The state health insurance will cover half of the costs for the most basic and cost effective solution. However, it is doubtful that this would be the solution you would choose.

Need help?

Our service partners from MW Expat Solutions are experts in the field of health care insurances for expats in Germany.

As an independent insurance broker, they work together with all the major insurance companies represented on the German market today. This means that MW Expat can help you find the insurance that you need at a good price.

Get in touch

phone: +49 89 2441729 0

email: office@mw-expat.com