The German healthcare system has long been considered one of the best in Europe and is certainly the oldest of its kind. When it comes to funding, the model for medical insurance in Germany is a multi-payer system, funded by the government, employers, and private individuals. Most residents including foreigners are enrolled in the public healthcare system, but around 10% choose private medical care.
This article will give you an overview of the German health insurance system and will cover more specific topics such as the costs of health insurance, how sick days work, and what is the difference between statutory and private ones.
German Healthcare System Overview
It is mandatory by law for all residents and visitors in Germany to have some sort of healthcare cover, whether that’s statutory public healthcare, private healthcare, or some other valid form for short-term visitors. You must have health insurance in Germany, no matter whether you are unemployed or employed.
When it comes to health insurance, Germany may seem to have a complicated system, but in fact, it's much more straightforward than it first appears.
How does German health insurance work?
There are two health insurance systems: the public and the private health insurance.
The vast majority of residents in Germany are part of the statutory public healthcare insurance system (Gesetzliche Krankenversicherung, GKV) whereby contributions from employers and employees are paid via social security payments. This is paid to one of the main public healthcare insurers, such as our partner Techniker Krankenkasse (TK), which hospitals and doctors make claims to whenever their services are used. The public healthcare system is heavily subsidized by the German government.
Some can choose between public and private health insurance. If you’re eligible for private healthcare insurance (Private Krankenversicherung, PKV) such as our partner ottonova (e.g. as an international student), you can access the same services and doctors, as well as some private-only doctors and hospitals.
Healthcare in Germany is excellent, and those who use the public system ultimately receive a similar level of care as those who use the private system; however, those on a private insurance package may also be able to access additional healthcare add-ons such as advanced dental treatment or private doctor’s offices and hospitals.
What is the difference between private and public health insurance in Germany?
The main differences between public and private healthcare is the health coverage it offers, how it is paid for and who’s eligible for it.
Here are some of the differences between public and private health insurance at a glance:
Public health insurance:
• Almost everyone can take out public insurance.
• Your contribution depends on your salary: the more you earn, the more you must pay (up to a maximum rate).
• If you earn over €62,100, premiums can reach up to €1,050 a month for self-employed and €541 for employees.
• Medical providers bill the public insurance directly.
• Coverage can be canceled by the government.
Private health insurance:
• Employees with a salary above the annual income threshold of €69,300, self-employed persons, civil servants, and students are eligible for private insurance.
• Your monthly premium does not depend on your salary.
• Premiums depend on your health status, the desired scope of benefits, and your age of entry.
• Medical providers bill the insured person, and they submit the invoice afterward and get reimbursed by the private health insurance.
• Coverage can be more extensive (e.g., visual aids, single or double room in the hospital, dental care)
• Benefits are guaranteed for the entire duration of your contract.
Find out more about private insurance on our Private Healthcare in Germany page.
What is statutory health insurance in Germany?
Around 90% of the German population use public healthcare. Any employee earning under €69,300 a year will automatically be enrolled for this kind of health insurance.
The premium for public healthcare is paid for by a combination of employee and employer contributions. A part of the employee's gross wage, totaling 14.6%, plus an average extra contribution of 1.7% (which varies depending on the provider), and possibly up to 4% for long-term nursing care insurance (for individuals over 23 without children), is deducted for your public healthcare.
If you are an employee of a company, you are entitled to employer contributions. However, if you are self-employed, you pay the whole amount by yourself. The coverage you recieve is the same for you regardless of whether you are a self-payer or not.
Although enrolment in the public scheme is mandatory for most, individuals can still choose from different health insurance providers (called Krankenkassen).
Find out more about statutory health insurance on our Public Healthcare in Germany page.
How does private health insurance in Germany work?
Employees earning above €69.300, freelance workers, self-employed people, civil servants, and students have the option to choose private healthcare insurance instead.
Private healthcare may also be paid for by a combination of employer and employee contributions (in the case of employees and civil servants; self employed pay as well the whole premium themselves). The premium is not calculated based on your income but on your age, your health status, your chosen tariff, and the coverage that you get.
So, with private health insurance, you can choose the level of your health coverage, which is often more extensive in many cases, like dental care, visual aids, or free choice of doctors and hospitals.
Find out more about private insurance on our Private Healthcare in Germany page.
Do I need health insurance in Germany?
Yes, it is compulsory for every resident in Germany to be covered by healthcare insurance. As well as public and private healthcare, health insurance coverage for EU citizens living in Germany for the short term can come in the form of an EHIC (European Healthcare Insurance Card) issued from an applicable EU country.
Health insurance coverage for non-EU citizens can sometimes take the form of private healthcare cover from your home country, but you will need to check that your plan covers you for living in Germany and for accessing German healthcare services.
How to get health insurance number and card in Germany?
Once you have started contributing to the public healthcare system, you will receive a healthcare insurance number and card (Krankenversichertenkarte). You will need to take this card along to all appointments because the doctor's office bills the insurance company directly
If you’ve signed up for private health insurance, you will receive an individual insurance number as well but don't worry if you do not get an insurance card. Since you are billed as a private patient yourself by the doctor’s office, you will then submit the invoice to your private health insurer.
What is the cost of health insurance in Germany?
The premiums for private health insurance are not based on your income but on your age, your health, and your chosen coverage. So, the cost of healthcare in Germany for those who choose private cover can differ.
Public healthcare contributions, on the other hand, start for employees at 7.3% of your gross salary, which is matched by your employer to make up a total of almost 15%. Those in employment also automatically pay an individual surcharge depending on the chosen public health insurance, as well as a compulsory nursing care contribution (Pflegepflichtversicherung) of around 2.5-4%, which is intended to cover the cost of care in later life.
For students aged over 23 and under 30, publich health insurance with long-term care costs €125.21 a month, regardless of your level of income. EU students may be covered by their EHIC card, but they have to exempt themselves by providing a letter from a public health insurance fund. Students between 23 and 30 years old with a child, and students under 23 pay €120.34 for public health insurance and the long-term care.
The costs for private health insurance plans vary from provider to provider. With our partner ottonova you can take out private health insurance for students incl. long-term care without deductible starting at 111€ (depending on your age and health status.)
Health insurance for international students
You can organize your student public or private healthcare plan quickly and conveniently with Expatrio. Find out more about your options for student health insurance with our partner TK or ottonova on our Health Insurance for Students page.
What does health insurance cover in Germany?
German public health insurance generally covers visits to doctors as well as basic dental care, surgery, outpatient appointments, and essential or non-cosmetic in-hospital treatments.
Private health insurance covers the same services as well as additional health care (e.g. visual aids, private doctors, and hospitals, single or double room in the hospital, worldwide coverage).
How to cancel health insurance in Germany?
Any social security contributions will naturally stop being made when you stop working or studying in Germany. However, to cancel your public or private insurance plan, you will need to contact the provider.
Dental care
Routine procedures such as check-ups, annual teeth cleaning, and fillings are generally covered by the state public healthcare or your private health care insurer. This means that you do not necessarily need to take out any additional dental insurance, although the high cost of major dental work means that additional dental insurance could save you money in the long run. Major dental work includes procedures such as fitting crowns or dentures. If you a private health insurance customer, you do not have the option of opting-in for additional add ons like extra dental insurance.
Always ask your dentist for a full cost breakdown (Heil-und Kostenplan) and show this to your healthcare insurer before proceeding with any work. If you are publicly insured, sometimes the insurer will only pay out 60-80% of the work and you will need to cover the rest yourself. Private health insurers can cover up to 100% of the costs.
The quality of dentistry in Germany is considered especially high, and a good thing to know is that you should never experience a shortage of trained dental staff in Germany – not even outside of the major cities and in smaller towns.
Language barriers for non-German speaking residents can be an issue, but many dentists, especially in cosmopolitan areas, will generally have a good level of English. It is worth searching for English-speaking dentists if you require one, but just know that if you have public insurance, this may limit the number of professionals available to you.
Health insurances with good customer service like ottonova or TK may even have an appointment service to help you find an English-speaking doctor.
Sick leave in Germany
Thanks to excellent employment laws in Germany, falling ill should not be too much of a worry when it comes to your job. Employers are required by law to pay for up to six weeks (for physical or mental ailments that mean you cannot fulfil your role) at full pay, but this can be extended should the circumstances require it to. After six weeks, employees can apply for Sickness Allowance (paid for by your public health insurance) which is 70% of your pay and payable for up to 78 weeks.
If you have private health insurance, make sure to take out daily sickness allowance too. It is worth for employees and especially self-employed people ensuring you’re also covered for sickness payment if you get sick and can’t work.
Students who are unwell should inform their tutors that they cannot attend lectures. You may be able to get an extension on an assignment. Many universities in Germany place huge importance on well-being and even offer free counseling to help deal with stress and anxiety. Take advantage of these free services wherever possible. You can always find out more about the sickness policy and well-being services at a given university by contacting the Student Services Centre.
Sickness in Germany, Dos and Don’t
- DO Always inform your employer of your sickness before working hours begin and ideally before going to the doctor – basically, as early as possible.
- DO always try to get an official sick note (Krankschreibung) from the very first day of being ill. This usually means you must go to the doctors on your first sick day, as the doctor will not always backdate sick notes. Some employers will say you do not need a sick note for the first three days of being ill, but always check this.
- DO get your flu shot once yearly before winter; many doctor’s surgeries will issue this for free.
- DON’T try to go to work or university if you have a cold or any other infectious illness; even if you feel you can struggle through, and you have plenty of work to do, coming to work with an infectious illness will not be appreciated by your colleagues.
- DON’T fake sickness. Remember, you can’t always just call in sick to your employer; often, you will need to go to the doctor immediately to get a sick note and have the sick day authorized, so faking an illness will be particularly difficult and deceptive.
Pharmacies in Germany
It’s important to familiarize yourself with the location of your nearest pharmacy (Apotheke). Pharmacies in Germany are easily identified thanks to a red ‘A’ logo which is displayed outside. Unlike in the US or UK, pharmacists are only allowed to own up to three premises, which means there are no chains of branded pharmacies. Don’t confuse a drugstore (Drogerie) with a pharmacy; the former is a place to buy toiletries and wellness products, while the second stocks prescription and over the counter medicine.
Pharmacists in Germany require a high level of training and can often be helpful in finding the right non-prescription medicine for your needs. You will need a doctor’s prescription (Rezept) to obtain medicine that has been prescribed to you, and will need to pay a small charge (Zuzahlungspflicht) if you have public health insurance. Private health insurance covers the costs for prescribed medicine mostly in full.
The laws on dispensing medicine are relatively strict in Germany in comparison to other countries, which means medicines you can normally buy over-the-counter at home may require a doctor’s prescription for in Germany.
List of common words for health insurance in Germany
It’s a good idea to familiarize yourself with words and phrases associated with healthcare and healthcare insurance before you move to Germany.
Useful German healthcare words:
- Apotheke = Pharmacy
- Gesetzliche Krankenversicherung (GKV) = Statutory public health insurance (such as TK)
- Krank = Sick
- Krankenkassen = Non-profit associations that administer public healthcare insurance, like Techniker Krankenkasse (TK)
- Krankenschwester = Nurse
- Krankenversichertenkarte = Health insurance card
- Krankenwagen = Ambulance
- Öffentliche Krankenhäuser = Public hospital
- Pflegepflichtversicherung = Nursing care insurance
- Private Krankenversicherung (PKV) = Private health insurance (like ottonova)
- Private Krankenhäuser = Private hospital
- Rezept = Prescription
- Versicherung = Insurance
Useful German healthcare phrases
- Ich bin krank = I am sick/ill
- Ich fühle mich unwohl = I feel unwell
- Ich fühle mich echt mies = I am feeling really unwell
- Ich brauche einen Krankenwagen = I need an ambulance
- Mir ist schwindelig = I feel dizzy
- Ich habe Fieber = I have a fever
What to do in an emergency
In case of an emergency, call 112 for an ambulance. This number can be used in all EU countries. If you cannot explain what you need in German, ask for an operator that can speak English, there is no guarantee that someone will be available, however.
You can also phone 116-117 for non-urgent medical queries; this line is managed by the German National Association of Statutory Health Insurance Physicians.
FAQ: Health Insurance in Germany
