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Public Health Insurance Germany

Everyone living in Germany needs either public health insurance or private health insurance. About 90% of German residents have public health insurance. It’s important to get insurance as soon as you arrive to Germany. This useful guide has all the information you need on public health insurance in Germany. Find out about how it works, how much it costs and what is covered. Then you’ll be able to choose a public health insurance provider in Germany!

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How Does The German Health Care System Work?

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Public & Private Health Insurance

The German healthcare system is made up of two parts: public health insurance and private health insurance. It is a universal multi-payer healthcare system. Most people living in Germany have public health insurance. A limited group of people qualify for private health insurance. If you are a civil servant, student, freelancer or earn more than 60,750€ per year (2019) then you can apply for private health insurance. Click here to learn more about private health insurance. 

Public and private health insurance have many significant differences. For example, public health insurance might be the cheaper option for families but might not cover all the same speciality treatments as private health insurance. 

Compulsory

Before you settle into your new life in Germany you need to get German health insurance. It’s compulsory for German residents. In addition, non-EU citizens usually have to provide proof of German health insurance to get a visa/residency permit for Germany. Make sure that your health insurance company meets the visa/residency permit requirements in Germany. 

It’s important to note that the European Health Insurance Card (EHIC) cannot be used as a substitute for German heath insurance. If you have the EHIC from your home country then you still need to apply for German health insurance. See our FAQ below to learn more about the EHIC. 

Top Healthcare System

Germany is known for having one of the best healthcare systems out of any country in Europe. Whether you move to a large city like Berlin or a smaller city like Heidelberg, you will get good medical care. 

How Does Public Health Insurance In Germany Work?

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Principle of Solidarity

Around 90% of Germany residents have public health insurance. Public health insurance in Germany is based on the principle of solidarity. This means two things. First, it means that everyone must contribute money to the public health system (unless you qualify for private health insurance). Secondly, it means that everyone gets the medical care they need, no matter what. Public health insurance companies are not allowed to deny you coverage or increase your premium due to preexisting health conditions or health risks. The cost of your premium depends on your income. 

Coverage, Services, Rates

There are over 100 public health insurance companies in Germany, so you have a lot of options. You will find that most public health insurance companies provide similar coverage. The most noticeable differences within public health insurance companies is their quality of customer service and their additional contribution rates.

It is really important to choose a public health insurance company that has services in English. For example, your insurance should have customer support and online forms available in English. 

The state contribution rate is set by the government (14.6%). In addition, public health insurance companies have their own contribution rate. This is called the additional contribution rate. It is usually a very small percentage of your income. Each public health insurance company has a different rate. You should choose a provider with a rate lower than 1%. 

Eligibility Requirements

If you earn less than 60,750€ per year (2019), then you are required to have public health insurance. There are a few exceptions*. Health insurance is mandatory, but you are free to choose whichever public health insurance company you want. Your employer will help you set up public health insurance and payments. 

Getting insurance is fairly easy for foreigners from EU countries had insurance through their home country’s public healthcare system. Non-EU foreigners qualify for public health insurance in Germany if they work in Germany or are married to a German.

*Students, civil servants and freelancers are eligible for private health insurance. If this applies to you then click here to learn more. 

Public health insurance is also called state or statutory health insurance (SHI). In German it is called gesetzliche Krankenversicherung (GKV).

What Is Covered By German Public Health Insurance?

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Medical Care

The German National Association of Statutory Health Insurance Funds regulates public health insurance companies to make sure they provide coverage for necessary medical services. Therefore, every pubic health insurance company provides basic medical care and services. This includes visits to general practitioners, immunizations, hospital care, prescription medications, detection and diagnoses, therapy and more.

In general, you can expect necessary medical care to be covered under your plan for no additional cost. However, you will have pay extra for additional care that insurance companies do not deem as necessary. For example, in many cases you will have to pay out-of-pocket for dental work. 

Coverage For Dependents

One of the biggest benefits of having public health insurance is that all of your dependents are covered under your plan for no additional cost. For example, let’s say you have three children and a non-working spouse. You do not need a separate insurance policy for each of them. They would all be covered under your plan. (The opposite is true for private health insurance.)

Who Is Able To Get Public Health Insurance In Germany?

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You are required by law to have public health insurance if you earn less than 60,750€ per year (2019). Students, self-employed/freelancers, state officials and people that earn more than 60,750€ p.a. can choose to have public health insurance or private health insurance. If you fall into one of these categories, click here to learn more about private health insurance. 

How Much Does German Public Health Insurance Cost?

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Basic Costs

The cost of public health insurance depends on your income. Usually it is between 180€ (lower income) and 800€ (higher income). 

As of 2019, the German state healthcare contribution is 14.6% of your income. Your employer and you split this cost equally. In other words, your employer is responsible for paying 7.3% and you’re responsible for paying the other 7.3%. For example, if you make 1,000€ per month then your state healthcare contribution is 146€. Your employer and you would split this and each pay 73€. Your state healthcare contribution is taken directly from your paycheck. 

Additional Costs

All necessary medical services are covered under public health insurance. Usually there are no additional costs. Examples include general practitioner visits and immunizations. In some cases you have to make a small copayment. For example, the copayment for prescription medicines is between 5€ and 10€.

There are some medical services that public health insurance providers do not consider necessary. Examples include major dental work or private hospital rooms. For these types of medical services you would have to pay an additional cost. 

If you would like to get insurance for additional medical services then you can purchase supplementary private health insurance. Supplementary private health insurance tops off your public health insurance. You can get insured for things like alternative medical treatments or premium dental care. 

Benefit Of Cost Based On Income

As mentioned above, the cost of public health insurance based off your income. This might be a disadvantage for people earning more than 60,750€ per year. However, there is an advantage as well. If you lose your job or retire then the price you pay for public health insurance will decrease. To the contrary, the cost of private insurance will increase as you get older, regardless of your job status. 

Which German Public Health Insurance Should You Choose?

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Services & Rates 

The the amount of medical care that public health insurance providers cover is very similar. Therefore, the biggest difference is the quality of their customer services and their additional contribution rates. 

TK Services in English

Techniker Krankenkasse (TK) is one of the best public health insurance companies, especially for expats. TK has a website and reliable customer support, both in English. Their application forms are also available online and in English.

TK Additional Contribution

TK’s additional contribution rate is consistently one of the lowest rates of all insurance companies in Germany. As of 2019, TK’s additional contribution rate is only 0.7% of your income. Since January 1, 2019 the additional contribution rate is split between employers and employees. Therefore, if you have TK then you only pay 0.35%. 

* See our FAQ below to learn more about Germany’s healthcare contribution rates.

Frequently Asked Questions (FAQ)

What Is The Best Public Health Insurance In Germany?

The best public health insurance in Germany is Techniker Krankenkasse (TK). TK one of the largest and most reputable health insurance companies in Germany. They are especially well-known for their service for expats/foreigners living in Germany. 

Benefits of TK health insurance: 

Services in English: If you do not speak fluent German then TK is a great option. It is one of the few German health insurance companies that has customer support available in English, a website in English, and application forms in English. 

Lowest prices: TK has one of the lowest additional contribution rates. 

Family insurance: Dependents (e.g. children and spouse) are included for free.

Coverage when traveling abroad: On the back of the TK health insurance card is the European Health Insurance Card (EHIC). Use can use the EHIC at most public hospitals in European countries. Click here to see a list of all the European countries that accept this card. 

Is Health Insurance In Germany Free?

No. Health insurance in Germany is NOT free. Both public health insurance and private health insurance cost money. The cost of public health insurance is based on your income. The cost of private health insurance is based on many different factors. These factors include your age, pre-existing health conditions, deductible and number of dependents.

Benefits Of Public Health Insurance

Less expensive when you’re older 

The cost of public health insurance is based on your income. To the contrary, private health insurance is based on your age and health risks. Therefore, when you are older public health insurance will be the cheaper option. In addition, you will pay less for health insurance if you lose your job or retire. 

Coverage for dependents

Public health insurance covers your dependents for no additional cost. In other words, your children and spouse can get coverage through your insurance and you don’t need to pay extra. 

Easier to manage

Public health insurance is more straightforward than private health insurance. After you receive medical care, the doctors and insurance providers workout the payment between themselves. You don’t have to do anything. If the price increases for a necessary medical service you don’t need to take on any extra payments. You don’t have a deductible. It’s less to worry about and much easier to manage. 

Disadvantages Of Public Health Insurance

More expensive for young working adults 

Public health insurance is based on your income. Private health insurance is based on your age, health and number of dependents. If you are young, healthy, don’t have children and earn a high income then public insurance will cost more money than private insurance.  

Longer waiting times

Germany has some of the lowest wait times for doctor’s appointments in Europe. Nevertheless, people with public health insurance will wait longer for doctors’ appointments than people with private health insurance. 

Extra medical care not included

Medical care that is not considered necessary is not included under most plans. Examples include major dental work and private rooms in hospitals. You would have to pay out-of-pocket. Private insurance lets you choose your coverage, and therefore you can include speciality treatments. 

Best Health Insurance For Students

Students can have private health insurance or public health insurance. The best public health insurance for students is TK, and Ottonova is the best private health insurance. 

TK

TK has one of the cheapest additional contribution rates. They also offer medical coverage outside of Germany, and they have an application specifically for students online! In addition, all of their services are available in English. 

Ottonova

Ottonova has special rates specifically for expats. They are one of the cheapest private health insurance companies in Germany, and they also provide great coverage. Ottonova has a website in English and an app for your phone! You can apply online before you get to Germany and end your contract in just a few simple steps when you leave Germany.

Do I Need German Health Insurance?

Yes. In Germany health insurance is mandatory. Employees that earn less than 60,750€ per year have to be insured through the public healthcare system. If you are a state official, freelancer, student or you earn more than 60,750€ per year then you can apply for private health insurance. In 2020 the amount will increase to 62,550€. Click here to learn more.

Coverage Abroad

European Health Insurance Card (EHIC)

If you have public health insurance in Germany then in most cases you can get the EHIC. With the EHIC, you can go to public health hospitals and doctors in the EU, Norway, Iceland, Liechtenstein and Switzerland. The EHIC covers necessary medical care for a reduced price, or oftentimes, for free with public health hospitals and doctors.  

Travel insurance is not the same as EHIC. That is to say, the EHIC does not cover private medical costs. For example, the EHIC does not cover mountain rescues and emergency helicopter rescues. If you travel abroad then health officials recommend travel insurance for private medical costs.

What Is The State Healthcare Contribution?

State Contribution

The state healthcare contribution is how you pay for your public health insurance. The government decides the amount. As of 2019, the state healthcare contribution is 14.6% of your income. You split this cost equally with your employer. In other words, you pay 7.3% and your employer pays 7.3%. 

If you are a freelancer then you will have to pay the 14.6% contribution yourself. This is why many freelancers choose to have private health insurance instead. 

What Is The Additional Contribution?

Additional Contribution

The additional healthcare contribution is the amount of money insurance companies charge you in addition to the state healthcare contribution. It is usually less than 1%.

The state healthcare contribution is the same for everybody. However, public health insurance company get to decide their own additional contribution rate. Therefore, your additional contribution rate depends on which health insurance company you have. Dependents (e.g. family members) do not pay an additional contribution rate. As of January 2019, the employee and employer split the additional healthcare contribution cost. 

Example: The state healthcare contribution is 14.6%. You choose a health provider with an additional contribution rate of 0.8%. This means that your employer and you would split the total amount (15.4%) and each pay 7.7%. 

In 2019 the average additional healthcare contribution rate was .9%. It is expected to increase in 2020 to 1.1%. 

Copayments

The copayments under public health insurance in Germany are very low. 

Examples: 

Medicine – between 5 and 10€ copayment

Hospital stays – 10€ per day copayment

Medical care and rehabilitation for mothers and fathers  10€ per day 

Sociotherapy – 10% of the daily calendar costs 

The German National Association of Statutory Health Insurance Funds sets the prices for copayments. You can click here to go to their website (in German) to see more prices for copayments.

Best Private Health Insurance In Germany

Ottonova

The best private health insurance in Germany for expats/foreigners is Ottonova. Ottonova has cheaper prices for expats and services in English. For example, their website and customer support are available in English. They also offer great coverage. For instance, Ottonova covers medication costs, prenatal courses, glasses and contact lenses, speciality treatments, outpatient and medical treatment. Click here to learn more about private health insurance in Germany. 

Supplementary Health Insurance In Germany

Combining Private & Public Health Insurance

Supplementary health insurance in Germany is for people that have public health insurance but would like some of the coverage private health insurance offers. How? Private health insurance companies sell add-ons. These add-ons top off your public health insurance. For instance, your public health insurance might not cover dental care. Therefore, you could purchase dental insurance through a private health insurance company. Read more about private health insurance here