Health insurance Germany

German health insurance for foreigners

Public health insurance – how much does it cost?

All public health insurance providers in Germany charge the same basic premium of 14.6 per cent of gross income (2023), plus a supplemental charge that is an average of 1.6 per cent of gross income, with those premiums capped at a monthly income of €4,987.50. 

Those who earn more than that will not pay a higher insurance premium. The basic premium is split equally between employee and employer: 7.3 per cent each. Since 2019, employers have been required to pay half of the supplemental charge as well.

Residents of Germany and their dependents must also become members of the country's long-term nursing care scheme (Pflegepflichtversicherung). This covers some of the cost of meeting personal nursing needs, including the bathing and feeding of those who become substantially disabled. 

The nursing care scheme cost varies based on the number of children a person has, although it generally runs from 3.4 per cent of a person's gross salary with at least one child or 4.0 per cent (with a maximum of €199.50 per month) for a person with no children, of which the employer pays a maximum of €84.79. These figures vary slightly for the state of Saxony, where costs start at 2.2 per cent for a person with one child and 2.8 per cent for childless individuals. The employer contribution in Saxony is also lower, at 1.2 per cent.

Public health insurance – what does it cover?

The minimum threshold all health insurance coverage in Germany has to meet includes:

• in-patient (hospital) care as a ward patient 
• out-patient care from a general practitioner or medical specialist (such as a cardiologist) 
• prescription drugs
• pregnancy care
• basic dental care
• employee sick note 
• statutory sick pay when the employer’s duty to pay it is over (up to 90 per cent of a person's net salary)

 
In addition, all non-working dependents – spouse, civil partner and children (up to a specified age) – living at the same address as the policyholder in Germany will be covered under the plan at no additional cost. They simply need to be registered with the same health insurance provider as the paying member.

Although the medical provision provided by public health insurance in Germany is fairly extensive, additional care may require additional payment – so it is essential to know what coverage is included. For example, while basic dental care is covered, aesthetic teeth cleaning may incur an additional fee.

Private health insurance in Germany – who can get it?

Germany does offer the opportunity to opt for private health insurance (private Krankenversicherung or PKV for short), but only for:

• those who earn more than a predetermined amount (€66,600 per year in 2023),
• those who are self-employed,
• and university students, who can choose private health insurance for the duration of their our studies

 
However, even if one of these criteria is met, no one is obligated to choose private health insurance. Anyone can still opt for statutory health coverage.

Private insurance – how much does it cost?

There are a few important factors that should be reviewed before considering private insurance. Although not impossible, it can be extremely difficult to enter or return to the statutory healthcare system once a person has a private insurance policy. In addition, monthly insurance premiums for private policies are not pegged to a person's salary. Germany's leading consumer reports organization, Stiftung Warentest, writes that the average person who first signs up for private insurance in their mid-thirties can expect their premium to rise to at least three times the original price by the time they retire.

Private health insurance – where to get it

A complete list of all private health insurance providers is available on this German-language website. However, given the differences in premiums and scope of coverage available, it is worth using a commercial price comparison website like Check24, Krankenkassen Deutschland and PKV-Gesundheit or a locally based health insurance broker, who can provide purchasing advice.

Private vs public health insurance in Germany – key differences

Although everyone has access to all healthcare institutions for doctor’s appointments and medical treatment with both types of policy, it is worth knowing the differences. For example, public health insurance does not cover needs such as dental implants, glasses or contact lenses or private rooms in hospitals, but a private insurance policy might cover several or all of these.

• While basic premium rates for public health insurance are the same (14.6 per cent) for all residents of Germany, regardless of income, private health insurance charges higher premiums that vary according to income, health and potential future health problems, and the risks a policyholder is willing to accept when purchasing a policy.
• Although pre-existing conditions are not an issue with public health insurance policies, that is not the case for private coverage. Still, because private health insurance providers in Germany are legally obliged to accept anyone, nobody can be denied coverage because of a pre-existing condition.
• German private health insurance adopts the same style of system found in any general insurance policy. Each month, a monthly premium is paid and a level of excess (or deductible) is selected on top of that. For example, a €400 excess translates to the policyholder paying the first €400 of healthcare costs before the policy kicks in. 
• Under the public health insurance scheme, policyholders face a co-pay of 10 percent of the cost of any prescription medicine, up to a maximum of 10 euros and a minimum of 5 euros per prescription. Those with private insurance policies must pay the full amount for prescriptions up front but will then be full reimbursed after submitting the receipt.
• It is important to note that while public health insurance policies also cover additional family members, this isn’t always the case with private health insurance. It is thus necessary to check the details of any private insurance policy, as it might be necessary to organise separate healthcare provisions for dependents.

Supplementary private insurance

Those who have public health insurance in Germany but want further coverage options can opt to enhance it with supplementary private insurance. While this will incur extra costs, it could come in useful for those seeking coverage for things not included in their public health insurance policy, such as additional dental care or treatment in a private hospital. 

Health insurance in Germany – when should I get it?

Ideally, those coming to work in Germany from another country in the EU should get their health insurance as soon as they arrive and are registered as a resident of Germany. Still, there is no cause for panic: Germany offers a brief grace period from the date of registration, and employers will also provide guidance through the process. 

Those coming from a country outside the EU, will need proof of valid German health insurance to obtain a residency permit. In such cases, new arrivals must have secured insurance coverage prior to arrival in Germany.