An introduction to public and private health insurance in Germany

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

• Compulsorily insured (Pflichtversichert)
  Employees who make less than 60 750€ per year^{in 2019} are compulsorily insured (Pflichtversichert). They can only choose public health insurance. Public health insurers are forced to accept them.
• Voluntarily insured (freiwillig versichert)
  Freelancers, people with minijobs and employees who make over 60 750€ per year^{in 2019} 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 insured^1, 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. There are multiple public health insurers (Krankenkassen) to choose from. Public insurers are non-profit companies.

Cost of public health insurance

The cost of public health insurance depends on your income. The contributions cost 14.6 to 15.6% of your income¹. The more money you make, the more expensive it gets. If you make more than 54 450€ per year^{in 2019}, the cost of contributions stops going up.

• If you are an employee, you pay 7.3 to 8.3% of your income, and your employer pays the rest¹.
  • If you make more than 54 450€ per year^{in 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 150€ 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 are a student under 30 years old, you will pay even less: around 90€ per month^{1, 2, 3, 4}.
  • 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, it should cost around 150€ per month. Use this calculator to estimate the cost.
• If you are a freelancer, you pay 14.6 to 15.6% of your income¹.
  • If you make more than 54 450€ per year^{in 2019}, you will pay around 815€ per month. Even if your income goes up, you won't pay more than that¹. This is the maximum amount for freelancers (Selbstständige Höchstbeitrag)¹. It changes every year.
  • If you make less than 12 460€ per year^{in 2019}, you will pay around 180€ per month^{1, 2}. This is the minimum amount for freelancers (Selbstständige Mindestbeitrag) in 2019¹. It changes every year. If your spouse or your parents have public health insurance, you can use their insurance for free.

Useful links:

• Health insurance calculator (Techniker Krankenkasse)
• Health insurance calculator (AOK)
• Health insurance calculator for Minijobs (Techniker Krankenkasse)
• Minimum and maximum contributions for freelancers (in German)

Benefits of public health insurance

• It's cheaper when you're old
  Public health insurance is based on your income. It will be much cheaper than private insurance when you get older. When you retire, your insurance will become very cheap, because your salary will go down. If you are over 45 years old, public insurance is almost always the best option.
• 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, refunds or deductibles. Private health insurance requires more paperwork.

Disadvantages of public health insurance

• It's 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 insurance^{1, 2}.
• 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 to Germany, it's really heard to get public health insurance. Public insurance companies are not forced to cover freelancers¹. Many freelancers are forced to choose private health insurance companies 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.

When I asked Rob this question, he immediately said "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 I moved to Germany, and I am very satisfied.

AOK is another very popular option.

Related guide: An honest review of Techniker Krankenkasse

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.

• It's 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.
• It's 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 you^1, 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.
• It's 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 an employee and earn more than 60 750€ per year (in 2019, before taxes), you can choose private health insurance.
• If you are an employee and earn less than 60 750€ 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.

Which private health insurance should I choose?

The difference between private health insurance companies is much bigger than for public ones. They offer much more options, and the best option depends on your situation.

In Rob's experience, Allianz is a very well organised internally. This means that they handle claims efficiently, and that they can offer slightly lower prices. He added that some insurance companies offer some special deals for certain professions. HanseMerkur is popular among expat freelancers.

Travel health insurance

Travel health insurances like aLC, Mawista and Care Concept are a very popular option for expats. Immigrants often use it to get their freelance visa, and switch to a real German health insurance as soon as possible.

This type of insurance is for temporary stays in Germany. If you stay longer than a few months, get a real German health insurance as soon as possible.

Why aLC, Mawista and Care Concept are a bad idea

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.

• 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.

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.

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.

Rob recommends to fully understand the difference between public and private insurance before you see a broker. 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 private to public health insurance can be extremely hard, and sometimes impossible¹. Public health insurance will often refuse to let you switch. If you are 55 years old or older, you can't switch to public insurance. It's almost impossible¹. 

Otherwise, people would be on private health insurance when it's cheap, and switch to public health insurance when they get old. Public health insurance companies would go bankrupt!

One way to switch to from public to private insurance is to reduce your income. Once your income is below 60 750€^{in 2019}, you are forced to use public health insurance. This does not work for freelancers.