Health Insurance and Healthcare in Germany Explained

How Does Healthcare Work in Germany?

Germany’s healthcare system and social security scheme have a good reputation. So, how does healthcare work in Germany? It is based on a dual public-private system.

Healthcare in Germany is divided into two sectors: the gesetzliche Krankenversicherung or Gesetzliche Krankenkasse (public health insurance or the statutory healthcare system, as the Germans prefer to call it) and private Krankenversicherung (private health insurance). In Germany, it is a legal requirement to have some form of health coverage, whether public or private, and it is even a requirement when starting a job.

How To Get Health Insurance in Germany

Your employer in Germany will typically take care of registering you with a German health insurance company, but in case you want to choose your own, they will ask for your medical insurance information beforehand. They might register you in the public system, so let your HR colleague know before you start your job if you want private insurance.

It is the employer’s duty to outline health insurance costs to the employee, as well as to deduct and forward the employee’s financial contribution automatically from the salary. The current health insurance contribution rate is between 14.6% and 15.6%, and the employer and employee pay half each.

One typical aspect of the German healthcare system is the coexistence of private and public providers. The option available to you depends on a variety of criteria. In both cases, you have many insurance companies to choose from; either way, employers and employees share the cost (though not always equally).

Facts about the German Healthcare System

• Does Germany have free public healthcare? Yes, all Germans and legal residents of Germany are entitled to free “medically necessary” public healthcare, which is funded by social security contributions. However, citizens must still have either state or private health insurance, covering at least hospital and outpatient medical treatment and pregnancy.
• But, what exactly does the public healthcare cover? It covers treatments and services, such as immunizations, prescriptions, and dental checks. This sort of national coverage helps keep average healthcare costs in Germany to a minimum and is one of the reasons the system has a positive reputation around the world.
• All salaried workers in Germany, whose gross monthly income is less than 5,213 EUR (5,800 USD) and whose annual income is less than 62,550 EUR (69,600 USD) as of 2020, must have public health insurance, also known as gesetzliche krankenversicherung (or GKV). You can also purchase additional insurance coverage from a private company. If you become eligible for private insurance, because, for example, you get a pay rise, you can change from public to private health insurance. However, you have to opt out of the statutory health insurance first—you cannot have both.
• If you start to earn more than 62,550 EUR (69,600 USD), you can continue to use the public health system if you want, as a voluntary user, but you will have to pay the maximum premiums.
• The percentage you will owe to the state-run healthcare system is taken out of your monthly pay. Germany’s healthcare contribution costs are 14.6 to 15.6%, half of which the worker pays, and half the employer. There may also be a small supplemental rate on top of this, at an average of 0.9%, which is paid solely by the employee. This supplement is a “contribution rate” charged by the state German health insurer.
• Applying for public healthcare insurance is relatively stress-free, as you simply need to register with the German authorities at your local town hall. Once you are registered, have a social security number, and are making your contributions, you will have access to the state-run healthcare.

Pros and Cons of Germany’s Healthcare System

Pros

• A well-developed health insurance sector.
• Contributions are based on income.
• You don’t need a doctor’s referral in order to see other specialists, such as a chiropractor.

Cons

• Patients who require overnight care are charged an additional fee, including for meals. This is typically not covered by many insurance companies.
• Some expats may not be able to sign up for private insurance as some insurance providers only accept people who have been living in Germany for at least two years.
• The higher your taxable income, the more you pay in contributions.

An Overview of Private Health Insurance

Health insurance in Germany works slightly differently to many other developed countries, in that the type of insurance you can access depends on precise earning amounts: those earning more than 62,550 EUR (69,600 USD) a year can choose private insurance, while those who earn less than 62,550 EUR (69,600 USD) are automatically enrolled to public health insurance.

Do You Need Private Health Insurance in Germany?

If you are covered by the state health system, then you do not need to have private health insurance.

Private health insurance is also available to self-employed people and German civil servants. For instance, civil servants, such as professors, are not obligated to be part of the state health insurance system. And, if you’re a freelancer, you can have private health insurance no matter your income.

The self-employed now pay less to contributions than before 2019, after public health insurance providers reduced the “hypothetical income” they expect self-employed workers to earn on average per month from 2,284 to 1,038 EUR (2,540 to 1,155 USD). Previously, if you were earning 1,000 EUR (1,110 USD) you had to pay 420 EUR (470 USD); now it’s around 190 EUR (210 USD) per month.

Also, if you earn less than 450 EUR (500 USD) per month and your partner earns a higher salary, you might be able to use your partner’s health insurance for free.

The application process for private health insurance is a bit more complicated. You may have to have medical tests, be required to answer a questionnaire concerning your medical history, and submit proof of your income.

Unlike with the public healthcare system, if you choose to go the private route or choose your own medical insurer, you will have to go through the selection and application process without your employer’s help. Private health insurance is not necessarily better than public health insurance, but you will be able to make an appointment sooner and be seen quicker. Also, you may have better access to doctors who speak your native language.

If you need a visa to come to Germany, or a residence permit to stay in the country, you usually have to show proof of healthcare coverage as well. Only if you have some sort of special status (e.g. when transferred to Germany for a limited period) is it sometimes possible to avoid signing up for health insurance in Germany.

Private vs Public Healthcare in Germany: What is the Difference?

One of the most important decisions is the choice between public and private healthcare plans. Several factors play a significant role:

• Your age
• Your legal status and family situation
• Your salary and occupation
• The intended duration of your stay
• The services and benefits you prefer

Private health insurance allows you to get certain medical attention faster. However, there are other things to consider: who is covered? What exactly is covered? How much will it cost? The answers to these questions reveal significant differences between public and private health insurance.

Most people use public healthcare, that is, the government’s healthcare plan, as private insurance is not available to everyone. In most cases, you can only choose private health insurance if your gross income from employed work exceeds 62,550 EUR (69,600 USD) per year. German civil servants are among the exceptions to that rule, but not many expats will find employment in the civil service.

Under certain conditions, the maximum premium for public health insurance is higher than the fees for private providers, making the latter more attractive. Thus, private health insurance can be of particular interest to adults in good health who have no kids and do not plan to stay in Germany indefinitely.

Also, patients with private healthcare, or a corresponding supplement to their public insurance plan, enjoy a number of other benefits as well. For example, you may stay in a single or double room at a hospital instead of a small shared room with three or four beds.

The major benefit of public health insurance is the fact that it extends to dependent family members. You don’t have to pay additional fees for your non-working spouse and children.

If you want to live permanently in Germany, especially with children, the government-sponsored option is often the better choice.

If you plan to stay in Germany for a short while only, you may benefit more from private health insurance. Also, private insurance requires you to get your spouse and kids insured separately.

The Benefits of Private and Public Healthcare

Private Public Faster service Available to all earning less than 62,550 EUR (69,600 USD) Convenient for a short stay in Germany Extends to dependent family members Can be cheaper than public premiums No extra fees for non-working spouse Access to exclusive doctors Children included in your plan Access to multilingual doctors Civil servants don’t have to contribute

Types of Health Insurance Plans

There are more than 100 companies providing health insurance in Germany. If you’re wondering how much health insurance is per month, the average cost varies considerably and depends on the health insurance coverage and whether you’re using the state system or private insurance.

The biggest public healthcare insurance providers in Germany are AOK, TK, and Barmer GEK. The most anyone has to contribute to public health insurance is 683 EUR (760 USD) per month.

On the other hand, some of the best-known private health insurance companies are:

• Allianz Private Krankenversicherung
• AXA
• Deutsche Krankenversicherung
• Signal Iduna
• Bayerische Beamtenkrankenkasse

Some medical coverage offers travel insurance outside the European Union or reimbursements for alternative medicine. Other providers offer benefits and reimbursements if you participate in preventative programs and get regular checkups.

Remember that prices vary depending on the extent of the cover you buy, your health, and age. So, please view the prices we quote as simply a guide of what to expect. If you’re planning on getting private insurance, here are some plans you could choose:

HanseMerkur private insurance for employees has a high rating on feedback website, eKomi. The monthly cost for HanseMerkur’s private insurance for employees is about 130 EUR (145 USD). These are some of the positives of its services:

• 500 EUR (560 USD) per year to care for a sick child up to 12 years old
• Preventative medical checks
• If you stay healthy, save 10% a month
• Treatment by a head physician
• A single or double hospital room

HUK-Coburg is another private health insurance firm in Germany. The monthly cost for their “Comfort” private insurance plan is about 280 EUR (310 USD). These are some of the features it offers:

• Medical treatment covered
• Drugs covered
• Massage, physiotherapy, and more
• 90 to 100% cover on walking aids
• Twice-a-year teeth cleaning

DKV has a 4.5 out of 5 rating from more than 7,400 reviews. The monthly cost for their Premium private insurance plan is about 250 EUR (280 USD). This is what you get with its “Premium” plan:

• Private hospital room
• Seen by the chief physician
• First 30 psychotherapy sessions
• Choice of hospital
• Coverage on hospital stay past 91 days

What if I Don’t Have Health Insurance?

Having no German health insurance means having to pay upfront for everything—unless it’s a serious emergency or you’re an EU citizen. Most EU citizens will get reimbursed for such emergency treatments by reciprocal insurance coverage between Germany and their home countries. However, for nationals of other countries, it will depend on the insurance plan they have in their country of origin.

For these and other reasons, acquiring a German health insurance plan is strongly recommended. Even then, some doctors only accept patients with private insurance. If you have public health insurance, make sure to look for a Kassenarzt who treats Alle Kassen (patients with any sort of German health coverage). Doctors and dentists with this Kassenarzt sign usually also treat European Health Insurance Card (EHIC) holders.

Please consider that small private hospitals in Germany might not have an emergency room. When you arrive at a clinic for an emergency, you’ll normally receive treatment even if you do not carry proof of health insurance with you. If you do not have any health insurance at all, the treatment will be very expensive. If you decide against a German health insurance plan, check with your insurance company at home whether they will reimburse you for medical treatment at hospitals in Germany.

What to Do in An Emergency

Should you need urgent care outside regular office hours, you can do one of the following things:

• Call your regular doctor. Even if they’ve already left the practice, the recording on their answering machine might tell you the phone number of the nearest emergency doctor.
• Look up the section called Ärztlicher Notdienst_or Ärztlicher Bereitschaftsdienst_ (emergency calendar) in the newspaper. It lists all physicians on stand-by for emergency duty, numbers of emergency hotlines, and pharmacies with 24-hour service.
• Take a taxi to the emergency room (Notaufnahme) of the nearest hospital.
• Call 112 or 19222 for an ambulance.

Admission to Hospitals in Germany

No matter which kind of insurance you have you should inquire which treatments your company covers and what costs it pays for. Usually, hospitals in Germany charge their patients a daily fee of around 10 EUR, in addition to any costs you may incur for diagnostics, surgery, etc. Depending on your personal health insurance plan, these fees may or may not be reimbursed.

Moreover, patients with private healthcare can demand to be treated by one of the hospital’s chief doctors. Apart from that, medical treatment is almost identical to that which those with public health insurance would receive. Regardless, there are some private clinics that are open only to patients with private health insurance.

Even though your general practitioner admits you to a hospital, they are probably not going to treat you. Only some medical specialists offer their services to nearby hospitals; they take turns working at their own practice and as part of the hospital staff (Belegärzte).

If your doctor cannot treat you personally, don’t hesitate to ask if they can recommend you a surgeon. In case your surgery is considered less urgent (e.g. hip replacements) or requires special examinations (e.g. by magnetic resonance tomography), your average wait for treatment will likely increase, as hospitals in Germany may put you on a waiting list.

When you go to the hospital (unless it’s an emergency), you need to register at the reception with proof of health insurance and an ID card or passport. Your bed would have already been reserved by your GP.

Your Stay in a German Hospital

Despite excellent facilities, some aspects of hospitals in Germany may seem odd to foreigners:

• There are no curtains around the beds. While receiving treatment in your room, you may be exposed to other patients.
• Hospitals in Germany provide neither pajamas nor towels. You should also remember to bring your bathrobe, toiletries, and a pair of slippers.
• Breakfast is rather simple with a cup of coffee or tea and a few slices of rye bread. Prepare for early meals. Supper might be served as early as 17:00. However, most hospitals in Germany do have a cafeteria, and unless you are on a special diet you are allowed to have private food and drinks in your room.
• Visiting hours may vary.

How to Find a Doctor or Dentist

Chances are that while you are in Germany, you might get sick or need treatment of some sort, so you will need to know how to find a doctor and dentist. If you aren’t self-employed or a stay-at-home parent, your company requires a health insurance certificate from a doctor in Germany in cases where you need to take sick leave.

The first step is to start looking for a general physician (GP) or family doctor in Germany (Allgemeinarzt, Hausarzt). If you suffer from a condition in need of special treatment and are wondering how to find specialists (Facharzt), your GP can recommend you one or refer you to a hospital (Klinik, Krankenhaus).

If you are wondering how to find a family doctor, or how to find a dentist, every doctor in Germany is listed in the local phone directory (Gelbe Seiten), under Ärzte. In major cities, there are a great number of physicians, with more than one doctor in most neighborhoods.

If you don’t know which doctor to choose, please contact your embassy or consulate for advice. They usually have lists with recommended doctors for most regions, especially in urban areas. However, those physicians tend to be in high demand.

Then there’s always the internet: German websites, like DocInsider.de and Jameda.de, allow you to search for doctors, and offer ratings and rankings from other patients. Another way of finding a trustworthy doctor is by word of mouth: ask people you are in contact with which doctors and specialists they recommend. InterNations’ expat communities in Germany are full of people willing to give advice like this.

A Step-by-Step Guide to Your Doctor’s Appointment

What you should know

• We recommend planning ahead when making an appointment with a doctor in Germany. You may not get an appointment for several weeks.
• The average wait to see a doctor in Germany in the public system is about 4 days, while it is 3.3 days in the private system.
• If your case is urgent but not an emergency, go to your general practitioner (GP). But still, be prepared to spend some time in the waiting room.
• Most practices have office hours from Monday to Friday between 08:00 and 18:00, with two hours’ break, usually between 13:00 and 15:00.
• Many practices close on Wednesday afternoons.
• If you have a regular appointment with your family doctor in Germany, simply show up a few minutes in advance.
• First, you need to talk to the doctor’s assistant or receptionist (Sprechstundenhilfe, Arzthelfer/-in) and tell them your name. Please keep in mind that most assistants speak little or no English.
• Hand the receptionist your health insurance ID card and, if you’re seeing a doctor for the first time, you may also have to fill out a medical history questionnaire.
• Then it’s time to settle in the waiting room.
• While most young doctors in Germany speak English, don’t rely on anyone knowing another language. You can ask your embassy for a list of bilingual physicians.
• You might be asked to undress.
• Your doctor in Germany may be rather assertive.
• If you’d like to get more information on your condition, just ask.
• After an examination, the receptionist will hand you any required prescriptions, referrals, or sick leave certificates, and will ask you for a follow-up appointment if necessary.
• If your insurance doesn’t cover the appointment and other needs, or if you’re privately insured, the administrative staff will send you the bill.

Getting Dental Treatment in Germany

Dental work in Germany can be quite expensive, and you often need to present a cost estimate to your insurance provider prior to getting treatment. Also, it is not always guaranteed that your insurance company deems the work necessary, as they strictly differentiate between cosmetic work and medical treatment, and therefore might not reimburse you.

The percentage that your insurance, be it private or public, will pay depends on the type of coverage you’ve selected. Some dental work is covered in standard medical insurance; it varies greatly depending on the procedure and the individual.

Quite a few Germans take out additional private health insurance coverage for dental treatment. This kind of top-up insurance option is called Zahnzusatzversicherung or Zahnschutz-Zusatzversicherung.

How to Get Medication in Germany

You can only pick up your medication at pharmacies (Apotheke), of which there are many to choose from in most cities. Prescription and non-prescription drugs may be obtained at pharmacies (Apotheken, marked by a large red “A”) anywhere.

Medication can be expensive, depending on the coverage you have from your insurance. However, patients enrolled in the public health insurance scheme do not have to pay the full price for prescription medicine, but only 10% of the costs. Usually, this sum amounts to five or ten euros for most prescription drugs.

Giving Birth in Germany

If you or your spouse have state-funded German health insurance, even if you’re a non-resident, the cost of giving birth in Germany, including post-natal care, is covered by the insurance company. If you have private health insurance in Germany, you should check with your insurer for further details about medical care for mother and baby.

If you are having a baby in Germany as a foreigner, keep in mind that giving birth in Germany does not grant your child citizenship. Only children born to a German parent get citizenship immediately. Giving birth in Germany as a permanent resident may also grant your child citizenship if you are an expat who has lived in Germany for at least eight years and had permanent resident status for at least three years.

Giving Birth in Germany Without Health Insurance

If for whatever reason, you’re not covered by any health insurance while in Germany, for example, you only planned to stay in the country for a short time and you weren’t yet eligible for local health insurance, this is what it will cost you:

• A regular birth could be between 1,600 and 7,500 EUR (1,780 and 8,340 USD)
• A C-section could cost between 2,500 and 5,400 EUR (2,780 and 6,000 USD)

With insurance, a regular birth would only be between 0 and 350 EUR (390 USD), while a C-section would be between 0 and 420 EUR (467 USD).

The Benefits of Giving Birth in Germany

Like all other forms of healthcare in Germany, the medical standards of caring for mother and baby are usually high. However, your individual experience depends on your gynecologist, obstetrician (Geburtshelfer), midwife (Hebamme), and nurses.

Prenatal Care

In Germany, you can buy a pregnancy test (Schwangerschaftstest) at any drugstore or pharmacy. Once you get a positive result, you should make an appointment with your gynecologist (Frauenarzt). As soon as you’ve decided to have the baby, prenatal care (Schwangerschaftsvorsorge) will begin.

At your first prenatal checkup, you will be handed a little booklet called Mutterpass (literally translated to “mother’s passport”).

It serves as a medical confirmation of your pregnancy, a record of your medical history (both general and pregnancy-related), and an official document for administrative purposes. You need to bring it along to every prenatal checkup so that your obstetrician, gynecologist, or midwife can record the latest exam results.

Routine prenatal care in Germany usually includes:

• Monitoring the pregnant woman’s blood pressure and weight
• Taking blood and urine samples at every gynecologist appointment for protein, sugar, and nitrate
• A blood test every other month to check iron levels
• Monitoring the fetal heartbeat
• Regular pelvic exams

You may also have tests for:

• Blood group and Rh factor
• An antibody test to see if your baby has a different Rh to you
• An optional HIV test
• Rubella immunization

You can also get an immunization for toxoplasmosis and a test for cytomegalovirus. These are recommended but are unlikely to be available through public health insurance.

In the course of your pregnancy, you may attend ten or twelve of these examinations. In the third, sixth, and eighth month of your pregnancy, your gynecologist will also perform an ultrasound exam (Ultraschalluntersuchung).

As stated above, your health insurance provider normally covers all of these costs. Regardless of your insurance status, your employer also has to give you some time off for such mandatory medical appointments, and all employed women with state-funded health insurance can go on maternity leave (Mutterschaftsurlaub) six weeks before the due date. If you are pregnant, you should tell your employer as soon as possible.

In Germany, fathers can also apply to take parental leave, which can be a total of three years’ time, up until the child’s eighth birthday, and can be split into three separate periods. However, there is no law requiring companies to give fathers any paternity leave, though they are often given about 1-2 days.

Having a Baby in Germany: Who to Turn To

In Germany, there is a definite distinction between a gynecologist (with their own practice), an obstetrician (who actually delivers babies in a hospital), and a midwife (who may work at a hospital, a birthing clinic, or may supervise homebirths). Usually, your gynecologist is in charge of prenatal exams, but they won’t be present for the birth unless they happen to belong to the resident staff of your chosen hospital as well.

A midwife is allowed to do prenatal checkups (except for ultrasounds), offer you advice on pregnancy-related questions or aftercare, and assist you in a routine delivery without complications.

If you’re looking for a midwife, you should check out Hebammensuche.de, a German-language search engine for officially registered midwives, allowing you to search using various parameters (such as “homebirth”, “yoga”, and bilingual midwives).