Health insurance in Germany: Essentials
- 90% of all residents in Germany are insured with a statutory health insurance company.
- Statutory health insurance, a cornerstone of the German healthcare system, operates on the principle of solidarity. This means all insured individuals receive the same benefits regardless of their circumstances. It’s a system that fosters a sense of community and inclusion.
- Age and state of health are irrelevant for admission to a statutory health insurance fund and the contribution amount.
- You can take out private health insurance as an employee with an annual income of more than €69,300 (status 2024) and a self-employed person or freelancer.
- Private health insurance, available to employees with an annual income of at least €69.300 and to self-employed individuals, often surpasses the benefits provided by statutory health insurance. This comprehensive coverage ensures you’re well-protected in any situation, giving you a sense of security and peace of mind.
The healthcare system in Germany
In an international comparison, Germany has an efficient and innovative healthcare system based on the two pillars of statutory and private health insurance.
German health insurance — compulsory by law
Healthcare services are accessible and affordable for everyone in Germany. Health insurance has been compulsory by law since 2009. Compulsory health insurance applies to German citizens and expats living in Germany. The government wants to ensure that residents have access to all essential health services regardless of their income or state of health.
Statutory or private health insurance
Your health insurance in Germany can be either statutory or private. 90% of all residents in Germany are covered by statutory health insurance. You can choose between 95 statutory health insurance providers.
Employees with an annual gross salary of €69,300 or more, as well as the self-employed, civil servants, and students, are free to decide whether to take out statutory or private insurance. Exceptions apply to international students who are not enrolled in a regular course of study but are attending a language or preparatory course. They must first take out private insurance for students.
Characteristics of statutory and private health insurance in Germany
The statutory and private healthcare systems in Germany each have specific characteristics. Here, we provide an overview of the most important characteristics and differences.
Statutory health insurance (Gesetzliche Krankenversicherung, GKV)
Accessibility
Statutory health insurance is compulsory for all employees with a gross annual income of less than €69,300. However, people with higher incomes, the self-employed, and civil servants can take out voluntary statutory health insurance.
The public health insurance funds are obliged to accept anyone eligible for the statutory healthcare system. There are no restrictions regarding age or state of health.
Funding and contribution levels
The statutory health insurance funds do not operate profit-oriented but according to the principle of solidarity. Members’ contributions finance healthcare services. Contributions depend on income and increase gradually up to the compulsory insurance threshold of €69,300.
The contribution to statutory health insurance is 14.6% of gross income. For salaried employees, the employer pays half of this. Students up to age 30 pay a standard contribution of €83 for statutory health insurance.
There are also additional contributions from the statutory health insurance funds, which vary depending on the fund.
Coverage
Under statutory health insurance in Germany, you receive a comprehensive range of outpatient and inpatient medical coverage based on regulations about standard care.
Insured individuals must make co-payments for specific treatments, aids, and medicines. Statutory health insurance does not cover medical services outside standard care.
Billing
Medical services are billed directly between the health insurance fund and doctors, hospitals, and other medical service providers.
Free choice of provider
You have a free choice of medical providers and can be treated by any statutory health insurance dentists and doctors licensed for the statutory health system.
Non-contributory family insurance
Spouses and children can be insured free of charge in the statutory health insurance scheme if their monthly income does not exceed the limit of €505 (mini-jobbers: €538). This regulation also applies to adult children up to 25 who are studying or completing their first vocational training.
Insurance cover abroad
As a person with statutory health insurance, you can take out insurance coverage abroad with the European Health Insurance Card (EHIC). It is valid throughout the European Union and in Iceland, Norway, Switzerland, and Liechtenstein.
Waiting periods
There are no waiting periods for statutory health insurance. You will receive full insurance coverage as soon as you become a statutory health insurance fund member.
Private health insurance (Private Krankenversicherung, PKV)
Accessibility
Private health insurance in Germany is aimed at specific groups—particularly high earners, the self-employed, and civil servants. Employees can only switch to private health insurance if their annual gross income is at least €69,300. Students can be exempted from compulsory insurance in a statutory health insurance fund at the beginning of their studies, after their family insurance expires, or at the age of 30 and switch to private insurance.
Before the insurance contract is concluded, private health insurance providers determine their risk through health questions. Insurance companies have the right to exclude certain pre-existing conditions and other risks from coverage, charge risk surcharges for them, or refuse insurance.
Financing and premium amount
With private health insurance, you choose a personalized tariff that offers you a contractually guaranteed scope of benefits. You can, therefore, customize your health insurance coverage.
The premium depends on the selected health insurance plan and your risk profile (age, pre-existing conditions, and certain private or professional risk factors). You can reduce the amount of your premium through deductibles.
Premiums are calculated for a group of insured people with identical features at the start of insurance. They are increased if they no longer cover all health costs of this group.
For employees with private insurance, the employer pays 50% of the insurance costs (up to the upper limit of €421.77).
Some private health insurance providers offer favorable rates for students.
Coverage
Full private health insurance covers all relevant outpatient and inpatient healthcare services. As a rule, private health insurance coverage goes well beyond the standard care provided by statutory health insurance.
You receive all the benefits insured in your tariff for the entire contract term. Co-payments for specific treatments can be agreed upon in the insurance contract.
Billing
Your doctor will issue you with an invoice for treatments. You submit the invoice to your health insurance provider, who will reimburse you. Hospitalization costs can usually be settled directly between the insurer and the clinic.
Free choice of provider
You have a free choice of providers, including private doctors and private clinics.
Non-contributory family insurance
There is no non-contributory family insurance in private health insurance in Germany.
Insurance cover abroad
If you are privately insured, your insurance coverage abroad depends on the chosen tariff. A good policy should offer unlimited EU coverage and worldwide coverage for at least one year.
Waiting periods
If this is the first time you have had statutory or private insurance in Germany, waiting periods apply. The general waiting period is three months (except for accidents). Extended waiting periods of eight months apply for psychotherapy, dental implants, pregnancy, and childbirth.
The waiting periods do not apply if you were previously insured for at least three months or if you change your tariff.
Frequently Asked Questions — FAQ
Both systems have advantages and disadvantages.
The advantages of statutory health insurance include, for example, non-contributory family insurance and the fact that age and pre-existing conditions do not affect eligibility for insurance.
Private insurance allows you to use a broader range of health services. Young, healthy policyholders can often expect very favorable premiums with private health insurance. In contrast, there is no non-contributory family insurance in private insurance. You also have to insure sick pay separately in a private policy.
Independent product evaluations and test reports can help you choose private health insurance. You can also seek advice from insurance brokers or independent experts.
We recommend the fully digital private health insurance policies from FinTech insurers ottonova and Feather to expats. They have tailored their services to the needs of expats in Germany. They offer their services entirely in English.
You apply for your health insurance online with your chosen public health insurance company. If you are eligible for statutory health insurance, they will send you an insurance confirmation and your insurance card. After one year, you can change your health insurance provider if necessary.
It is worth comparing statutory health insurance companies in Germany due to the different additional contributions and benefits. The insurance company Feather offers expats an English-speaking advisory service for this purpose. You can take out insurance directly through Feather with selected statutory health insurance companies.
For every month without health insurance in Germany, you may have to pay a fine, calculated based on the average monthly contribution of around €400 for statutory health insurance.
EU citizens and expats from Switzerland and certain countries in the European Economic Area are also considered insured in Germany with the European Health Insurance Card (EHIC).
