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?
State Health Insurance („Gesetzliche Krankenversicherung“)
One thing first: Health Care Insurance is mandatory in Germany, however you do have options.
State health insurance is mandatory unless you earn over €64,350 per year before tax, under €450/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 he will contribute is €384.58/month for your health care and €73.77/month for your nursing care insurance. Should the premiums be higher, the costs are covered solely by yourself.
The Gesetzliche Krankenversicherung (‘GKV’) is a family insurance, this means that partners with an income lower than €450/month and children are automatically insured with you 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.
The ‘GKV’ is obliged to insure you regardless of your health history.
Health Care in Germany is of a very high standard, regardless of which system suits your personal situation best. For health care to be considered to be compliant by the German authorities it has to cover everything that is regarded as medically necessary. In particular reimbursement limitations are not permitted.
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 earning well, it is normally possible to obtain a far superior health care coverage in comparison with the state health care plan for lower monthly premiums. If you have a partner who does not work or several children then private health care is normally less cost-effective than the state schemes.
Once in the private health scheme, it is very difficult to go back to the state health scheme should you wish to do so. If you are privately insured after the age of 55 then there are very limited ways to change to the state system.
The Private Krankenversicherung (‘PKV’) is not obliged to offer you insurance should you not meet their entry criteria regarding health. Some private insurers will not insure people coming from abroad without them having lived in Germany for a period of time.
There are many different tariffs available, making it possible to design the health care coverage that is tailor made for your needs. These range from the free choice of doctor or hospital, choice of hospital room (single room, double room, etc.), cover for alternative health care, dental care and opticians.
Depending on the tariff you choose, you may have to pay a yearly excess charge or excess charges on individual benefits such as dental treatment or alternative health care.
Doctors receive higher reimbursements from private health care patients, meaning waiting times are normally far lower than for people insured in the state system.
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. Also there are no hidden costs which have to be covered solely by the patient, as may be the case in the state health care system.
Supplementary Health Insurance & Dental Insurance Germany
If you are state health insured out of choice or 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 the 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 with dental prostheses roughly 50% of the most economic but functional treatment will be paid for. 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.
A system of co-payments is in place. The areas where this system is implemented range from prescriptions, external remedies such as massages and a €10 co-payment charge for each day spent in hospital (max. 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 will need to be covered by yourself should you wish for a single or double room or to be seen by a senior physician.
The system in place for medical aids (hearing aids, wheel chairs, orthopedic shoes and stockings, etc.) is similar to the dental system. The state health insurance will cover about 50% of the costs for the most basic and cost effective but also functional solution, it is however doubtful that this would be the solution you would chose.
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 places MW Expat in a position to find the insurance cover that most suits your needs at the best possible value for money.
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