Public and private health insurance in Germany: how to chose?

Public and private health insurance in Germany: how to chose?

Health insurance (Krankenversicherung) in Germany is not free, but it's mandatory. If you stay in Germany for more than 90 days, you must have health insurance1. In this guide, we explain the difference between public health insurance (gesetzliche Krankenversicherung) and private health insurance (private Krankenversicherung). We also explain which one is better for you.

This guide was verified by 6 separate health insurance brokers. Special thanks to Rob from Feather, who answered my questions for several hours.

What are your options?

Germany has a multi-payer healthcare system. There are hundreds of private and public health insurance companies. You can choose any of them. This is different from the UK, Canada, Australia, France, Sweden, Norway and Finland.

Your health insurance is not tied to your employer. Your employer does not decide which insurance you have. If you lose your job, you do not lose your health insurance. This is different from health insurance in the United States.

Your insurance options depend on your income and your job status. Some people can choose public or private health insurance. Other people can only choose public health insurance.

There are two possible statuses:

Those people are voluntarily insured1, 2:

Public health insurance

Around 90% of German residents have public health insurance (gesetzliche Krankenversicherung or GKV)1, 2. It's also called statutory health insurance. Public insurers are non-profit companies. They are also called sickness funds (Krankenkassen).

The public system in Germany is different from the public system in the UK, Canada, Australia, France, Sweden, Norway or Finland. You have more than one health insurance option. You can chose any Krankenkasse for your health insurance.

Cost of public health insurance

The cost of public health insurance depends on your income. You pay 14.6% to 15.6% of your income every month1. If you make more money, your health insurance becomes more expensive. If you make more than 56250€ per year, the cost of health insurance stops going up. You just pay the maximum amount.

If you are a freelancer, the cost is based on your estimated income. If you paid too much, you will get a refund later. If you did not pay enough, you will have to pay more later.

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Benefits of public health insurance

Disadvantages of public health insurance

Which public health insurance should I choose?

Public health insurance companies (Krankenkassen) have very similar prices and coverage1. The biggest difference between companies is customer service1.

Rob from Feather says "as an expat, Techniker Krankenkasse is a no-brainer, by a long way." TK is very popular among expats, because it offers support in English. I have been with TK since 2015, and I am very satisfied. AOK is another very popular public option. DAK and Barmer are two other major public health insurers.

If you don't know which health insurance to pick, you should ask a health insurance broker. Their help is free. They get paid by the insurance companies when they bring new customers.

Useful links:

Private health insurance

Around 10% of German residents have private health insurance1. You can only have private insurance if you are voluntarily insured (freiwillig versichert).

Cost of private health insurance

The cost of private health insurance (private Krankenversicherung or PKV) depends on your age and your health. The older you get, the more expensive it gets. It will be cheaper than public health insurance when you are young, but much more expensive when you get old.

Employees only pay half of their monthly contributions. Their employers pay the other half. Freelancers must pay the monthly contribution themselves1. This is why health insurance seems so expensive for freelancers.

Who can have private health insurance?

Private health insurance is only an option if you are voluntarily insured (freiwillig versichert).

Which private health insurance should I choose?

There are big differences between private health insurance companies. Each insurer offers different options, and the best option depends on your situation.

The best way to choose private health insurance is to ask a health insurance broker. Their help is free. They get paid by the insurance companies when they bring new customers.

Use Tarifcheck to compare private health insurance prices. You enter some information about you, and you get many insurance options and their cost.

Rob from Feather says that Allianz is a very well organised internally. They handle claims efficiently, so they can offer slightly lower prices. He added that some insurance companies offer some special deals for certain professions. HanseMerkur is also popular with expat freelancers.

Ottonova is a popular option for expats because they offer support in English, but they have their issues.

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Travel insurance

Travel insurance covers you for a few weeks when you visit Germany. It only covers medical emergencies, and treatments that can't wait until you return home. It does not cover long term treatments, health checkups or preexisting conditions.

Travel insurance is enough to get a tourist visa, but it is not enough to get a German residence permit.

Expat health insurance

Expat health insurance covers you for up to 5 years. It's much better than travel insurance, but not as good as public or private health insurance.

There are two reasons to get expat health insurance:

Expat insurance has a few disadvantages compared to public and private health insurance:

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Insurance from other EU countries

If you stay temporarily in Germany, you can use your EHIC card. This proves that your health insurance back home covers healthcare in Germany.

If you are an Erasmus student from another EU country, the EHIC card is enough1, 2. You can use your EHIC card even if you study in Germany for your entire degree1.

Once you start working in Germany, your EHIC card does not cover you anymore. You must get a German health insurance.

The EHIC card is only available to European Union citizens. Read more about it here.

The Künstlersozialkasse (KSK)

The Künstlersozialkasse (KSK) allows freelance artists to save money on health insurance. When you are on the KSK, the state acts as your employer, and pays 50% of your health insurance contributions. If you qualify, it can save you a lot of money!

Applying for the KSK is a long, difficult process. They ask a lot of questions and require many documents. It can take up to 6 months. Staying into the KSK also takes a lot of effort. You must prove that you still qualify every year.

Insurance brokers

Insurance brokers can help you pick the best health insurance, but you still need to do your research first. Only insurance brokers can recommend health insurance companies.

Before you see a broker, understand the difference between public and private insurance. Only a few brokers specialise in public and private health insurance. Many only sell private health insurance, because it pays more.

Always look for independent insurance brokers. Don't choose brokers who work for a single insurance company. They will recommend this company even when it's not the right one for you.

How do insurance brokers get paid?

When you sign a public health insurance contract, the broker will get a commission between 0 and 90€. When you sign a private health insurance contact, the broker's commission is around 9 times your monthly payment. This means they can make above 5000€ in commissions for private insurance. They also receive money every year for "holding" your contract.

Many brokers only sell private insurance, because it makes them much more money.

Switching from private to public health insurance

Switching from private to public health insurance can be extremely hard, and sometimes impossible1, 2. If you are Pflichtversichert, public health insurers are not forced to accept you.

If you are over 55 years old, you can't switch to public insurance anymore1. It's almost impossible1. Otherwise, people would have private health insurance when it's cheaper, and switch to public health insurance when they are old. Public health insurance companies would go bankrupt!

One way to switch to from private to public insurance is to reduce your income and become Pflichtversichert again. Once your income is below 62550€in 2020, you are forced to use public health insurance. This does not work for freelancers, because they are never Pflichtversichert1, 2. They would have to become employees again, then use that technique.

Need help?

Health insurance brokers help you find the best health insurance for your situation. Only brokers can give health insurance recommendations.

I trust Feather and B-Protected. They helped me write this guide and helped many of my readers find health insurance. Rob from Feather helped me switch to private insurance and save over 500€ per month. Both Feather and B-Protected and have a lot of experience with expats. To compare health insurance prices, you can also use Tarifcheck.