Should you get public or private insurance? What if you’re a freelancer or a student? Here’s all you need to know about health insurance.
8 min read
Germany is well known for its strong state health insurance system and the high rate of insured residents. In fact, all residents in Germany—including self-employed individuals and students—must have health insurance by law, and you can’t get a residence permit without it. It’s one of the first things you should look into if you’re moving to Germany, so here are the basics on what healthcare in Germany looks like, and how to get insured.
Public health insurance
There are two kinds of health insurance systems. The first is public health insurance (Gesetzliche Krankenkasse), which accounts for the vast majority of insured residents in Germany. If you’re an employee and your gross income is less than €62,550 per year, or €5,212.50 per month, it’s compulsory to be insured under a public, statutory health insurance scheme, and you must choose an insurance provider. The three most common providers are TK (Techniker Krankenkasse), AOK and Barmer GEK. Benefits are nearly identical across these companies, but TK has the most English language resources, and is frequently recommended to expats. Click on this link to apply for TK insurance online, and you’ll hear back within a day with next steps. Your provider will issue an insurance card (Gesundheitskarte) with a chip, much like in a credit card, that you must present at every doctor’s visit.Each provider covers a basic set of medical care and services including general practitioner visits, sick notes, hospital treatment, immunizations, preventive care, prescriptions, dental examinations, detection and diagnoses, plus much more. The general rule of thumb is that medically necessary care is free, while additional care requires additional payment. For example, you can see the dentist for free, but a cleaning may cost you money. This is becoming increasingly common as the government attempts to sustain such a vast network of care while keeping costs down. Those of you who are unaccustomed to “free” public health care may experience the strange sensation of going back to reception to pay after you see a doctor, only to be reminded that you don’t have to.The price of a public health care plan is based on your gross income. You split the cost evenly between you and your employer, which comes out to around 8%. Additionally, if you’re insured through the state system, your family is also insured. Your spouse, along with your children (up to a certain age) are covered under your plan. This is the simplest solution that works for most people, especially those who work for an employer that arranges the paperwork.
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The second kind is private health insurance (Private Krankenversicherung), which you can choose as your primary form of insurance only if your gross income is higher than €62,550 per year, or €5,212.50 per month. This is also the case for freelancers and self-employed residents, who have the option to choose between public or private health insurance. It’s worth noting that if you already have public health insurance in Germany, you’ll have to opt out of your state insurance scheme and switch to private—and it can be difficult to switch back in the future. Private insurance is often more expensive than public, and it doesn’t cover your whole family. The price of your plan isn’t based on your income, but rather on your risk profile. So for example, older people generally pay higher prices than younger people.The advantage is that you enjoy more extensive coverage that includes exclusively private or semi-private clinics, subsidization of alternative treatments, subsidization of glasses and contact lenses and much more, depending on the provider. Doctors and hospitals welcome the additional income of serving private insurance patients, so wait times are typically much shorter, and you can often request a doctor who speaks your language. You can also shop around for a plan that best suits your needs and your budget over a wider selection of insurance providers than just going with a public plan. However, it’s important to keep in mind that many of these contracts are in German, and oftentimes, you’ll have to submit forms for reimbursement after a treatment—so you’ll end up paying for it out-of-pocket first. One of the easiest ways to get private insurance is to consult directly with an insurance expert. Click on this link to book a free consultation in English, and get an honest evaluation about whether a private plan is best for you, plus recommended plans from various providers. You won’t have to deal with any paperwork in German.
Supplementary private insurance
There’s also a type of insurance that occupies the space between the two. If you have a public health insurance plan, you can get an additional private plan (Krankenzusatzversicherung) that covers inpatient, outpatient and dental treatment. For example, your public plan may not cover dental treatment beyond checkups, so you want supplemental insurance for expensive dental work. Or you know that you’re covered for hospitalization, but would prefer a private room instead of a shared one. Look for supplemental coverage for health, travel, accidents, disability and others from the myriad of private health insurance providers in Germany.
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There’s actually one more type of insurance to explain, and it’s the most relevant if you’re a freelancer, job-seeker, or language school student right now. It’s called incoming insurance, and it’s perfect if you’ve recently relocated to Germany, but can’t sign up for public health insurance right away. For example, you might be coming from a non-EU country and you need to get a job before you can get public health insurance. Or you’re just young and healthy, and don’t plan on staying in Germany for more than two years. Think of it as a longer lasting travel insurance that provides affordable care and doesn’t restrict you from entering the public system later. Most importantly, it fulfills the insurance requirement for your residence permit so you can get legally insured as quickly as possible. Click on this link to apply for a policy online and get insured in a few hours, or sometimes, in only a few minutes. Just make sure to not stay on it for more than two years.
Private liability insurance
While not technically health insurance, private liability insurance, otherwise known as accident insurance, is one more thing you should consider to be completely covered. Known as Haftpflichtversicherung in German, this will cover you for up to €30 million in damages that you might accidentally cause to another person or someone else’s property. It will also cover you if you’re injured, or your property is damaged by someone without liability insurance. It’s supplemental to your health insurance because it extends to ambulance costs and lost wages, in addition to the medical bills. Click on this link to learn more and get covered for only €5 a month.
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As previously mentioned, this is the easiest way to get insured. If you make less than €62,550 per year or €5,212.50 per month, you will automatically be enrolled in the public health scheme, so your employer will complete all the required paperwork for you with your cooperation and your chosen insurance provider. Your payments will automatically be deducted from your monthly paychecks. If you make more than €62,550 per year, you can decide if you want to switch to a private insurance provider, and your employer will still make the arrangement with them.
How to get health insurance as a freelancer or self-employed person
If you’re a freelancer or self-employed, it’s all up to you to do the following steps:
Decide if you want to enroll in a public or private health insurance scheme
Choose a provider and find the right application form on their website
Provide basic personal information like your name, address and nationality
Provide employment information like your job title and start date
Provide previous insurance information like whether you’ve been insured in Germany before, and by whom
Send the completed form to the appropriate address, which is usually written on the form
Submit a recent passport photo to put on your insurance card
Set up a direct debit to get billed automatically
3. If you choose private health insurance, you must also choose your particular plan, and plans vary by cost and coverage. People typically recommend choosing a private plan if you’re young, in good health and don’t plan to live in Germany permanently.
How to get health insurance as a student
The process to get health insurance in Germany as a student is similar to the one as a freelancer or self-employed person, except you’ll have to submit the application form for students. Rates for students are considerably lower, so consult with your university’s office for international students first, and then make the following considerations:
Decide if you want to enroll in a public or private health insurance scheme
Choose a provider and find the right application form on their website
Provide basic personal information like your name, address and nationality
Provide academic enrollment information like the name of your university, specialty/major and expected graduation date
Provide possible employment information like whether you will have any income during your studies
Provide previous insurance information like whether you’ve been insured in Germany before, and by whom
Send the completed form to the appropriate address, which is usually written on the form
Submit a recent passport photo to put on your insurance card
Set up a direct debit to get billed automatically
There are clear advantages to both public and private health insurance. Regardless of your decision, you can take care of your payments easily by opening a free bank account online in Germany with N26. Discover which N26 bank account suits you best, then sign up directly from your smartphone in just 8 minutes.
FAQs
In Germany, it’s mandatory for residents to have health insurance. There are two categories of health insurance: public health insurance (gesetzliche Krankenversicherung, or GKV) or private health insurance (private Krankenversicherung, or PKV). Eligibility depends on factors like income and employment status.
"The cost of health insurance in Germany depends on whether you have public or private insurance. It can also depend on income, age, and health status.Public health insurance (GKV) is based on a percentage of your gross income. The base contribution rate is 14.9% of your gross income, split equally between you and your employer. This rate increases if your income grows.The cost of private health insurance (PKV), on the other hand, depends on your age, health condition, chosen coverage, and insurance provider. It's usually more expensive than public health insurance. And the older you are, the higher your contributions will be.
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"Yes, foreigners can get healthcare in Germany, but it depends on nationality, residency status, and health insurance coverage in your home country, such as the European Health Insurance Card (EHIC). Depending on your coverage, you might have to pay for services upfront and ask your insurance provider for a refund.
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You’ll have to pay for any medical costs upfront if you're not a resident. As a German resident, not having health insurance means risking a fine of up to 14 months of health insurance contributions (a maximum of €639.38 per month).
Yes, not having health insurance in Germany is illegal. Health insurance is mandatory for all residents, including German citizens and foreigners. Failing to have health insurance can lead to fines and difficulty accessing medical care.
Without insurance, many doctors in Germany may refuse to see you, except in emergencies. If you manage to go to the doctor without insurance, you’ll have to pay out of pocket for the full cost of the services.
Yes, you can go to a hospital in Germany without insurance, but only in emergencies or life-threatening situations. German hospitals are obligated to provide emergency care to anyone in need, regardless of their insurance status. Hospitals expect you to pay for treatment upfront if you don’t have insurance.
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