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

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

German health insurance seems expensive and complicated, but in this guide, we explain how to find the best insurance for your needs.

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 written with the help of 5 separate health insurance brokers. Special thanks to Rob from Popsure, who answered my questions for several hours.

What are your options?

Germany has a multi-payer healthcare system. You must choose which health insurance company covers your healthcare. There are hundreds of private and public health insurance companies to choose from.

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.

Your insurance options depend on your income and your job status. Most people can only choose public health insurance.

There are two possible statuses:

  • Compulsorily insured (Pflichtversichert)
    Employees who make less than 60750€ per year are compulsorily insured (Pflichtversichert). They can only choose public health insurance. Public health insurers are forced to accept them1.
  • Voluntarily insured (freiwillig versichert)
    Freelancers, people with minijobs and employees who make over 60750€ per year are voluntarily insured (freiwillig versichert). They must have health insurance, but they can choose public or private health insurance. Public health insurers are not forced to accept them.

Those people are voluntarily insured1, 2:

  • Students
  • Freelancers
  • Doctors
  • Civil servants
  • People with a single minijob1

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). There are multiple Krankenkassen to choose from.

Cost of public health insurance

The cost of public health insurance depends on your income. The monthly contributions are 14.6% to 15.6% of your income1. If you make more money, your health insurance becomes more expensive. If you make more than 54450€ per yearin 2019, the cost of health insurance stops going up. You just pay the maximum amount, around 400€ per month.

  • If you are an employee, you pay half of your monthly contributions (7.3 to 8.3% of your income). Your employer pays the other half1. The amount is taken directly from your paycheque every month.
    • If you make more than 54450€ per yearin 2019, you will pay around 400€ per month1. Even if your salary goes up, you won't pay more than that1. This is the maximum contribution (Höchstbeitrag). This amount changes every year.
    • If you are unemployed or make less than 12 460€ per year1, you will pay around € per month1. This is the minimum contribution (Mindestbeitrag). This amount changes every year. If your spouse or your parents have public health insurance, you can use their insurance for free.
    • If you have a minijob, you still need health insurance. If your spouse or your parents have public health insurance, you can use their insurance for free1. If not, you will pay the minimum contribution (Mindestbeitrag): around € per month. Use this calculator to estimate the cost.
  • If you are a student under 30 years old, you will pay even less: around 90€ per month1, 2, 3, 4. After your 14th semester, you will pay around € per month1, 2. This is the minimum contribution (Mindestbeitrag). If you are a EU citizen, you can use your EHIC card.
  • If you are a student over 30 years old, you will pay around € per month1, 2. This is the minimum contribution (Mindestbeitrag).
  • If you are a freelancer, you pay 14.6 to 15.6% of your income1. The amount is taken directly from your bank account every month.

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.

Useful links:

Benefits of public health insurance

  • Public is cheaper when you're old
    Public health insurance is based on your income. If you lose your job or retire, you will pay less for your insurance. When you are old, public health insurance will be much cheaper than private health insurance. If you are over 45 years old, public insurance is almost always the best option.
  • Public is cheaper for students under 30 years old
    Students pay around 90€ per month1 until they are 30 years old, or until their 14th semester.
  • It covers your dependents for free
    Public health insurance covers your children and your unemployed spouse. If your spouse only has a minijob, (s)he is covered by your insurance1. If you plan to have children, public health insurance is a better choice1.
  • It matches your income
    Public health insurance is cheaper when you make less money. If you lose your job or retire, public insurance will remain affordable. Private insurance will get more and more expensive, even if you become unemployed.
  • It requires less paperwork
    Public health insurance is simple. The doctors and the insurance companies talk directly to each other, so there is less paperwork to do. The price won't change as you get older. When you go to the doctor, you just show your insurance card and you're done. You don't need to worry about price changes, coverage, reimbursement or deductibles.

Disadvantages of public health insurance

  • Public is expensive for young professionals
    Public insurance is based on your income, and private insurance is based on your health. If you are young, healthy and have a good income, public will be much more expensive than private.
  • You don't get the best treatment
    Doctors make a lot more money from private patients, so they often treat private patients first1. With private insurance, you will get an appointment the next day, instead of in two weeks. It's also very difficult to find a psychotherapist or urologist who accepts public health insurance1, 2. You still get good treatment, but not the best treatment.
  • Special treatments are not included
    If you want special treatments, you will need to pay the extra cost yourself. When I had my wisdom teeth removed, my insurance only paid for local anaesthesia. General anaesthesia was more expensive, so I had to pay the difference myself. Private insurance lets you choose the quality of your coverage.
  • It's not available for everyone
    If you are a freelancer who just moved from a non-EU country to Germany, it's almost impossible get public health insurance. Public insurance companies are not forced to cover freelancers1. Most expat freelancers are forced to choose private health insurance because of this.

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 Popsure 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.

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.

  • Private is cheap when you are young
    A healthy 25 years old man could pay as little as 175€ per month (350€ for freelancers) for private insurance. If you make a good salary, this is much cheaper than public insurance.
  • Private is very expensive when you are old
    When you get old, you could pay 1500€ per month for the same insurance! This is a lot of money if you are retired. Your income goes down, but your insurance keeps getting more expensive1. This can easily bankrupt you1, 2. If you are over 45 years old, private insurance is rarely worth it. After 55 years old, it's almost impossible to go back to public health insurance.
  • Private is expensive if you have health problems
    You must take a health test before you get private health insurance. If you have any health issues that need constant treatment, your insurance will be much more expensive. If you have pre-existing conditions, they will often refuse to cover you1. This includes chronic diseases, psychotherapy or expensive medication, for example.
  • You choose what you need
    You can choose dental coverage, travel insurance, special treatment etc. If you choose more options, your insurance will be more expensive. If you choose fewer options, it can be very cheap.
  • You pay less with a higher deductible
    For example, if you have a 3000€/year deductible, you pay the first 3000€ in medical fees yourself, and your insurance pays everything after that. When you have a high deductible, you pay less in insurance every month. If you never go to the doctor, that's a good way to save money.

Who can have private health insurance?

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

  • If you are a freelancer, you can always choose private insurance. There is no minimum income. If you are a non-EU freelancer who just moved to Germany, private health insurance might be your only option.
  • If you are an employee and earn more than 60750€ per year (in 2019, before taxes), you can choose private health insurance. Your employer will pay half of your monthly contributions.
  • If you are an employee and earn less than 60750€ per year (in 2019), you can't be privately insured. You must have public health insurance. You can't choose private health insurance.
  • If you are a student, a doctor or a civil servant, you can choose private health insurance. If you are a student over 30 years old, private health insurance can be cheaper than public health insurance. Private health insurers offer special rates for students.

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.

You can also use tools like Tarifcheck to compare private health insurance prices. You enter some information about you, and they show you different options from different insurers.

Rob from Popsure 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 are not a perfect option.

Useful links:

Travel/expat health insurance

Travel or expat health insurance offered by aLC, Mawista and Care Concept are a very popular option for expats. Expat health insurance is useful when applying for a freelance visa, because it's cheap and easy to get.

These international health insurances are supposed to be for temporary stays in Germany. They offer limited coverage, and they do not meet the German requirements for long term stays. If you stay longer than a few months, switch to a real German health insurance as soon as possible.

Why expat health insurance is a bad idea

  • Long term treatment is not covered. They usually only cover treatments that can't wait until you return to your home country1. They do not cover pre-existing conditions. If you get a serious issue like cancer, they will only pay to send you back to your home country. Getting reimbursed can be difficult.
  • It does not include Pflegepflichtversicherung. This means they don't meet the German health insurance requirements1. You can't use it as your permanent health insurance.
  • The Ausländerbehörde does not always accept this type of insurance for visa applications. They can give you a shorter visa because you have travel insurance. They can also refuse to renew your visa until you get a real German health insurance. However, they seem generally accepted by the Ausländerbehörde in Berlin1.

When to get expat health insurance

  • When you intend to live in Germany for less than 5 years.
  • When you need insurance to get a German residence permit. You can switch to a real German health insurance after you get your visa.

Useful links:

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.

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 takes over a month. 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.

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 60750€in 2019, 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.

We trust Popsure. They helped us write this guide and gave us a lot of honest advice. They speak fluent English and have a lot of experience with expats. Keith Tanner is also recommended by many expats1, 2, but he is hard to reach. If you just want to compare prices, use a tool like Tarifcheck.

This article uses affiliate links. When you click these links and purchase something, we make a little money. We use that money to pay our hosting bill, expand the website and donate to charity. We don't sell recommendations or write reviews for money.

Comments

  • Nirali Patel

    Hello
    I m from India. I m leaving in Munich from last 3 month.i m here as family reunion type visa.My husband have work permit visa for 1 year.I m going to extent my visa. So which type of health insurance i have to take?

    Reply

    • Reply to Nirali Patel

  • Francesco

    Hi everyone and thanks for this useful guide.
    I have a question related to my particular case. I'm 32 years old and I came to Berlin in October 2018 to start a new job and I chose TK because was the one informally suggested by my employer.
    Now I enrolled an MA at Humboldt Universitat and I still don't know what kind of part-time job I will be able to do.
    What do you suggest? Should I keep TK and pay it by myself until I find a part-time job? Or should I switch to something else?

    Thanks in advance for your reply.

    Best,
    Francesco

    Reply

    • Reply to Francesco

  • Srinvias Akula

    There is a typo in the 3rd paragraph under the section "Switching from private to public health insurance"
    It must be "Switching from Private to Public" not the other way.

    Reply

    • Reply to Srinvias Akula

  • Oskar

    Hey, I found this site here https://www.check24.de/krankenversicherung/lp/en/health-insurance/. They claim to help you with your German health insurance for free. Does anyone have experiences with them? Check24 seems to be a quite large online broker

    Reply

    • Reply to Oskar

    • Nicolas Bouliane

      Yes Oskar, Check24 is trustworthy. Their service is free, but they get a commission from the insurance companies when they bring them a client. This is also how insurance brokers get paid.

      Reply

      • Reply to Nicolas Bouliane

  • Dennis Floyd

    This comment is awaiting moderation.

  • Stephen

    My wife is the main income earner working for a company. So far myself, her and our son are all on her public health insurance. But I have recently started as a kleinunternehmer but earn extremely little, so far I'd say under 2000 per year. By reading the article, can I assume that can still be insured under my wife's public health insurance(and not pay 190 per month)??

    Reply

    • Reply to Stephen

    • Nicolas Bouliane

      That's an excellent question. Normally, I think you'd be a dependent of your wife, but I don't know if that's true since you're self-employed.

      If you find the answer, please write back! I'll add it to this guide.

      Reply

      • Reply to Nicolas Bouliane

  • Sthandiwe Kanyile

    I am South African, looking to move to Germany for my PhD research. I'm 25 and required to have German health insurance for my visa, can I get this while in South Africa?

    Reply

    • Reply to Sthandiwe Kanyile

    • Nicolas Bouliane

      I am not sure. You need an apartment to get a bank account, and a bank account to get health insurance. You also need an address in Germany.

      There are lots of similar situations when you move to Germany. If you find the solution, please write back!

      Reply

      • Reply to Nicolas Bouliane

  • David

    What would be the health insurance options acceptable to get a temporary resident Visa for someone that is moving to Berlin for a two years study program at Potsdam University and it is 59 years old? Danke!

    Reply

    • Reply to David

    • Nicolas Bouliane

      This would be a better question for an insurance broker. The older you are, the more expensive it will be. If you are insured in your home country, a travel insurance could make sense.

      Reply

      • Reply to Nicolas Bouliane

  • Hayk

    Planing to relocate with family members: mother and wife for working in Escborn. Recentely got some tips that for parents cannot have public insurance and I have to take only private one because German rule have some restriction in such a cases.
    I am non EU, I am Armenian.

    Thanks in advance

    Reply

    • Reply to Hayk

    • Nicolas Bouliane

      Hello Hayk,

      There are lots of rules, but you should be able to get on the public health insurance system. I would recommend that you talk to an expert. Rob from Popsure helped us write this article, and he knows what he's doing. Keith Tanner is another well-known insurance broker in Berlin. Maybe you can ask one of them.

      Best of lucks

      Reply

      • Reply to Nicolas Bouliane

  • Lindsay

    What if you are employed making less that 60 750 euro/year but your spouse has Private Insurance. Can you join your spouse's private plan even though you are below the salary requirement?

    Reply

    • Reply to Lindsay

    • Nicolas Bouliane

      Hi Lindsay. Only public plans let you insure your unemployed spouse and your children for free. Private insurance charges extra for each person.

      Reply

      • Reply to Nicolas Bouliane

  • Jenny

    What happens if you are unable to work, as in the case of being disabled or homeless? Do you get public insurance? How will you pay for it?

    Reply

    • Reply to Jenny

  • Mikhail

    This is a good article, but it misses one critical aspect of private health insurance. The main thing is that PKV is financed by you and it has a savings effect. When you pay it being younger your insurance actually accumulates your contributions in their fonds and they will those money to sponsor the service when you're old and very much need it. The private insurance companies accrued already ridiculous amount of money. So they won't charge more and more the whole your life, it's a myth, after some age (let's say 70) the payment stabilizes and they can even start charge less, because hey, you have not so many years ahead anymore. So it won't be definitely 1500 euros per month. You'll pay this amount maybe if you started to contribute at 50 or later! I might be wrong in exact numbers, but you should get the principle.

    For the public insurance the picture is a bit different. Of course, it will get cheap when you're retired. But it's a distributive system. Your hefty medical bills will be sponsored by high-paying young and healthy workers. And the biggest issue with that is the ageing population. There will be more and more retired people and even less young workers. By now researchers predict, that in order to make those ends meet by 2050 the required contribution to the public insurance will rise from current 15% to 25-30%. Here you should ask yourself, what will happen if well-earning young workers of the future decide that those high contributions are not worth it and leave the public system en masse... Probably they will just start to cut coverage of public insurance (it happens already), or doctors become more and more reluctant to handle publicly insured patients (it happens already). Or maybe nothing happens! Maybe Germany will always be able to attract enough young skilled immigrants to pay increasingly high taxes. Who knows... I wouldn't be so sure saying that public health insurance is always the safest option, at least long-term. I myself is very concerned about it.

    Reply

    • Reply to Mikhail

  • Alejandro

    Nice, that this kind of infos is in english, but sorry, some points are wrong!
    If you loose your job then you will switch automatically to Pflichtversicherung, if you are younger 55. You mentioned the GKV is cheap, when you retire. Yeah, but how is the coverage. Hoy much of your own pocket do you have to pay in case you are sick?
    If you are in the PKV and lit save the delta to the GKV, you can finance the higher costs of your health insurance and deduct it from the taxes.
    By the way: if you get Grundsicherung im Alter abd you have a PKV, the government will pay for it. Then there are Rentertarife....

    Reply

    • Reply to Alejandro

    • Nicolas Bouliane

      Hi Alejandro,

      I asked Rob about your feedback, and it's not quite correct. You can only get back to Pflichtversicherung once your average income for the last 12 months goes below the 60 750€ limit (as of 2019). If you are a freelancer, you have to find a job that pays below 60 750€. It's far from easy.

      The coverage for GKV is set into law. The coverage for PKV is set by your insurance policy. Your calculation about PKV is correct as long as you make a high income your entire life. If you are a freelancer and your salary goes down for a few years, or if you decide to have children, PKV is a bit of a gamble.

      You are also correct about the government helping you if you absolutely can't pay for PKV yourself. However, you will still need to pay as much as you can, and that will affect your standard of living.

      In the end, it's a very personal decision that's affected by many variables. GKV is generally a safer choice, especially if you don't know what you are doing. Choosing PKV requires a lot more long-term planning.

      Reply

      • Reply to Nicolas Bouliane

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